Wiki Self-limiting/Minor Diagnoses

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tlm5506

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Hello.

In the midst of cold/flu season, I code for a family practice provider who has been seeing a lot of "itis" patients. The diagnoses most common are bronchitis, pharyngitis, otitis media, etc. The provider gives a prescription probably 95% of the time. I am considering these diagnoses and self-limiting/minor. My provider is disagreeing with me. So I am asking for anyone's help. Are these diagnoses really self-limiting/minor? I always have had troubling distinguishing those types of diagnoses with other ones. Thanks.
 
I agree with you. Here's how I try to explain it. If the problem warrants the initiation of a new treatment plan it's not self-limited. If the problem does not warrant the creation of a treatment plan, it's self-limited. A script for an 'itis' problem doesn't warrant an ongoing treatment plan and MDM is low.




tlm5506 said:
Hello.

In the midst of cold/flu season, I code for a family practice provider who has been seeing a lot of "itis" patients. The diagnoses most common are bronchitis, pharyngitis, otitis media, etc. The provider gives a prescription probably 95% of the time. I am considering these diagnoses and self-limiting/minor. My provider is disagreeing with me. So I am asking for anyone's help. Are these diagnoses really self-limiting/minor? I always have had troubling distinguishing those types of diagnoses with other ones. Thanks.
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It depends on the treatment. Often bronchitis needs antibiotics anti histamines and anti pyeritics etc. The MDM depends on treatment plan. We have to combine the condition and the treatment to decide.

Ramnath Bandaru CCS, CPC
American Medical Services LLC.
 
I have always considered self limited to be something that would go away by itself, would not need a rx to treat. So my thought is if the provider is giving a rx then this condition would not get better by itself therefore I count it as a new problem with no workup and rx drug management making it moderate mdm.
 
Most of this is pretty gray.

If it needs a prescription, it is by definition NOT "self-limiting. The question here, though, is did the patient really need a prescription? Since 95% of patients get prescriptions, I wonder if he's just handing them out to be on the safe side for conditions that would, in most cases, actually be self-limiting.

Whether or not it is "minor" is even more ambiguous; unfortunately, CMS does not give us enough guidance. They do say that a "cold, insect bite, [or] tinea corporis is minor," but they don't give any more examples. So a "common cold" would definitely be "minor," but would pharyngitis and otitis media be minor? I don't know. I certainly would not consider bronchitis to be "minor."
 
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