Wiki Self-limited or minor problem vs Acute, uncomplicated illness/injury

[rmness]

There is a debate regarding self-limited or minor problem vs acute, uncomplicated illness/injury in our office. Per the AMA:
Self-limited or minor problem: A problem that runs a definite and prescribed course, is transient in nature, and is not likely to permanently alter health status.
Acute uncomplicated illness/injury: A recent or new short-term problem with low risk of morbidity for which treatment is considered. There is little to no risk of mortality with treatment, and full recovery without functional impairment is expected. A problem that is normally self-limited or minor but is not resolving consistent with a definite and prescribed course is an acute, uncomplicated illness.

When the problem is what would be considered a self-limited or minor problem, but there was treatment we look at it as an acute uncomplicated illness which in most cases changes the level from a 2 to a 3.

Example: Patient presents with a sore throat, a strep test is done which is negative, provider tells patient to purchase over the counter lozenges and chloraseptic spray, follow up if the problem persists. Because OTC treatment was done we have been viewing this as an acute uncomplicated illness which is low MDM, minimal data for the one lab test, and low risk for the OTC products for treatment which would be a 99213. If the problem were viewed as self-limited or minor it would be a 99212.

Is it appropriate to change a problem from a self-limited/minor problem to acute uncomplicated illness when there is treatment?

 

[Chelle-Lynn]

Yes, we would consider the sore throat to be an acute uncomplicated illness as the provider recommended OTC medication as a treatment consideration. The American Academy of Family Physicians considers UTI, sinusitis, and sore throats as uncomplicated acute illnesses.

https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/emcoding-series-part-three.html#:~:text=Uncomplicated%20acute%20illnesses%2C%20such%20as,result%20in%20hospitalization%20or%20death.

 

[rmness]

Yes, we would consider the sore throat to be an acute uncomplicated illness as the provider recommended OTC medication as a treatment consideration. The American Academy of Family Physicians considers UTI, sinusitis, and sore throats as uncomplicated acute illnesses.

https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/emcoding-series-part-three.html#:~:text=Uncomplicated%20acute%20illnesses%2C%20such%20as,result%20in%20hospitalization%20or%20death.

Thank you so much for your response, I greatly appreciate the resource!!

 

[Gator]

We consider self-limited/minor problem as an "ask mom" issue. Rash, bug bite, fatigue, common cold etc. However, we were once told that if a patient is seeking treatment for XYZ then it is often times converted to an acute uncomplicated. Because "Not resolving consistent with a definite and prescribed course" means that XYZ is not improving or healing as normally predicted, following a usual time table or usual pattern that is expected for XYZ. Basically XYZ it's not getting better as it should despite any self treatment or no self treatment the patient has done to try to improve it, and the progression/healing of XYZ is not following the standard course of recovery. If XYZ has a known, typical pattern of how it usually progresses and resolves, with a predictable timeframe but, fails to do so it then should be considered an acute uncomplicated.
However, if the normal course of a sore throat is lets say 1 week and patient presents at day 2 with worsening pain that may not, depending on who is looking at it, be enough to call it acute uncomplicated. That may be the normal progression & healing of a sore throat. The whole of the note would have to be considered.