Pediatric Coding Alert

Question: When is a problem a new problem? Example: A patient is seen in the emergency department (ED) for abdominal pain that got worse. The ED physician found nothing. A pediatrician sees the patient two days later for persistence. In regards to medical decision making complexity, should I consider the problem new or established? Pennsylvania Subscriber Answer: When determining a problem's status using the CMS standard documentation worksheet (available at www.highmarkmedicareservices.com/partb/reference/pdf/scoresheets/8985.pdf), consider the problem new when it is new to the examiner. Provided the problem is not self-limited or minor (stable, improved, or worsening), the sheet assigns more points to a new problem than to an established problem. The increased values account for the added work involved in the physician making the differential diagnoses and weighing the treatment options as part of medical decision making's "Number of Diagnoses or Management Options." "Generally, decision making with respect to a diagnosed [...]