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Wiki 2021 E&M guidelines and what "1 undiagnosed new problem with uncertain prognosis" means

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wynonna

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So who can tell me what this means "1 undiagnosed new problem with uncertain prognosis" . I'm seeing it under moderate under "Number and complexity of problems addressed".
MD puts Nasal Vestibulitis-- J34.89-- as only dx under assessment.
He prescribes Mupirocin, an RX. Patient is new.
Would this be a 99203 or 99204?
 
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Well, it's not undiagnosed. Nasal Vestibulitis is a diagnosis by itself. You might want to query the provider about the uncertain prognosis part, but if that's all the provider put about the diagnosis, I wouldn't think it's too serious. However, don't take my word for it. Hopefully, someone else will respond with better info.
 
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It's "1 previously undiagnosed new problem." So if the pt came in for a problem and this was diagnosed as something the patient didn't have before, it's a new problem the doctor is dealing with. So that Makes it a "Moderate" level problem plus there's prescription drug management which makes it Moderate risk. 99204

Tom Cheezum. OD, CPC, COPC
 
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So, to make sure I understand, "1 previously undiagnosed new problem" takes extra work for the provider because he/she has to assign a final dx based on patient's signs, symptoms, and chief complaint. Also factored in is tests analyzed or ordered/considered. So the fact that the provider is working to establish a definitive dx increases the complexity of Medical Decision making for "number and complexity of problems addressed? I see how this is interpreted and I also see that this may be a big consideration between a level 3 and 4 New patient. So unless the final diagnosis is made by another provider, we can count it for new patients under "One previously undiagnosed new problem?."
Thank you so much for your clarification.
 
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One other point. If the patient was diagnosed with a problem by another provider and they switched medical practices and doctors, those problems diagnosed by the prior doctor are "new" to the new provider. They would have to confirm that the prior diagnosis and treatment are correct by discussing things with the patient and evaluating test results etc. An example might be something like a patient who has been diagnosed and treated by doctor A but decides to change to Doctor B for some reason. That's a new patient with a new diagnosis, at least for Doctor B, who would now determine if the patient's treatment is working properly and perhaps even change treatment. Maybe the patient wasn't happy with treatment by Doctor A due to medication or disease side effects the patient didn't feel were being addressed properly, so they decided to change to Doctor B. IMHO Doctor B should be able to get MDM credit for both dealing with the, to them, "new" diagnosis and its subsequent treatment.

Tom Cheezum, OD, CPC, COPC
 
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