Acne table of risk category

JesseL

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Would you call facial acne that a person had for years self limit minor problem OR a stable chronic illness?
 

thomas7331

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I would agree. Per CPT, a self-imited or minor problem is defined as one " that runs a definite and prescribed course, is transient in nature, and is not likely to permanently alter health status OR has a good prognosis with management/compliance." If the patient has had the issue for years, then it does not meet that definition.
 

JesseL

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I'm just looking at the 2021 E&M rules.

If acne is considered a chronic illness then that means on the 2021 rules, if someone has worsening acne and there was some prescription drug management then that makes the visit a 99214, since 2021 E&M rules will no longer be based on history or exam but MDM or time, which seems pretty steep. And there's already supposedly a rate increase on E&M codes for 2021?
 

thomas7331

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Well, it's not up to the coders to say what 'seems pretty steep' or not. We don't make the rules, we just apply them. ☺

In any case, it really isn't a big change. A visit for a patient with worsening acne with prescription drug management could likely involve a detailed history and/or exam, which could be coded as 99214 under the current rules too. I'd note too that Appendix C of CPT includes visits for treatment of acne in clinical examples for both 99213 and 99214 visits:

99213:
Office visit for a 13-year-old, established patient, with comedopapular acne of the face which has shown poor response to topical medication. Discussion of use of systemic medication.

99214:
Follow-up visit for a 15-year-old withdrawn patient with four-year history of papulocystic acne of the face, chest, and back with early scarring and poor response to past treatment. Discussion of use of systemic medication.
 

JesseL

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Well, it's not up to the coders to say what 'seems pretty steep' or not. We don't make the rules, we just apply them. ☺

In any case, it really isn't a big change. A visit for a patient with worsening acne with prescription drug management could likely involve a detailed history and/or exam, which could be coded as 99214 under the current rules too. I'd note too that Appendix C of CPT includes visits for treatment of acne in clinical examples for both 99213 and 99214 visits:

99213:
Office visit for a 13-year-old, established patient, with comedopapular acne of the face which has shown poor response to topical medication. Discussion of use of systemic medication.

99214:
Follow-up visit for a 15-year-old withdrawn patient with four-year history of papulocystic acne of the face, chest, and back with early scarring and poor response to past treatment. Discussion of use of systemic medication.
Wouldn't that 99214 example fall under 99213 under current rules (2 pts for Est. problem worsening and moderate under risk) if not factoring history and exam?
 

thomas7331

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Wouldn't that 99214 example fall under 99213 under current rules (2 pts for Est. problem worsening and moderate under risk) if not factoring history and exam?
But you do have to factor in history and exam (and also any data points or other factors that may be applicable) under current rules.

The clinical examples in the appendix are just that, examples only, and aren't meant to be coded from - per the disclaimer in CPT: "These clinical examples are used to describe presenting problems that are frequently encountered in a given specialty. Typical patients with such problems may commonly require the listed Evaluation and Management (E/M) service. Therefore, these examples are not appropriately used for any review of correct coding or estimating physician or qualified health care professional work. These clinical examples do not encompass the entire scope of medical practice."
 
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