Define self-limited or minor problem for MDM

eeoo

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What constitutes a self-limited or minor problem in deciding Medical Decision Making for E&M services?
 

LLovett

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The examples they give are cold, insect bite, tinea corporis. I have had several coding educators, some of them physicians, explain self limited or minor as a problem that will go away on their own without treatment. I have also had a doctor use the example of, if it makes him want to ask the patient "You came in here for that???" it is probably under this category.


Hope this helps,

Laura, CPC
 
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Does that mean if it is a new problem and a prescription is given (otc or Rx), then it is no longer self limiting, but a new problem w/o additional workup planned?

Carol
 
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Well ...

Well, just because some patients won't leave the office without an Rx doesn't mean the problem isn't still "self-limiting." I'd especially consider this when the Rx is for something readily available OTC (Ibuprofen for example).

F Tessa Bartels, CPC, CEMC
 
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Love Coding!

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The patient reports to the clinic with concerns about itchiness of the scalp. This onset roughly three days after having her hair dyed. It is slowly getting better, however, the patient is still in a fair amount of discomfort due to her itchiness. Since this onset there has been no treatment for it. The remainder or the past medical history, family history, social history and a complete review of systems has been reviewed and noted in the chart.

Objective: On exam, the patient a well appearing female, alert and oriented. Skin examination of the head and neck reveal erythema only in the areas of the scalp. There is no scarring nor alopecia in the area. The remainder of the patient's skin exam in unremarkable.

Assessment/Plan: Contact dermatitis. The patient was advised to notify her cosetologist and determine which other products may be appropriate for her. She was given samples of Clobetasol (prescription) to apply to the scalp once a day before bed to see if this is helpful in resolving her condition more rapidly.

We code on 95 guidelines, what do you get for this established patient visit?

Thanks,

dscoder74
 

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Thank you Tessa, I thought the same thing!

Exam = 2 body areas

MDM

Self limited or minor problem = 1 problem point

Risk = moderate prescription drug mgmt

Amount of data reviewed = 0
_________________________________

99212
 

SCanterbury

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Regarding the original topic, this is what the CPT book says:

"Self-limited or minor: A problem 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."

Since that is as clear as mud and can easily apply to more serious problems that many would have no problem labeling as "new problems," I usually add what has been posted already in my instruction, that "self-limited" refers to a problem that will usually self-resolve in a few days and really doesn't need medical intervention at all.

Also, here is what one Medicare contractor said:

"Follow-up Questions from the 8/23/06 E&M MDM/PROBE FINDINGS 99214 & 99215 TELECONFERECE with WPS Medicare.

Q) Some of my staff attended a seminar earlier this year and asked for a definition of self-limiting or minor problem vs. a new problem. They stated that someone from WPS said if it required a prescription it's considered a new problem. Is that true?

ANSWER: If a prescription is needed to manage a problem, it is usually not self limited. However, there are some self-limiting problems that will resolve themselves, but a drug is prescribed to help treat symptoms. In the end, the nature of the presenting problem and the diagnosis will determine whether the problem is minor or self limiting."

Seth Canterbury, CPC, ACS-EM
 
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RebeccaWoodward*

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Well Seth...It's good to see you here. I was hoping you were going to answer one of my questions on the Part B List Serve today. Good to have you aboard.
 

NishaJ

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Hi Frnds....
im also having doubt in this concept....
how we can conclude any condition whether it is self limited or minor condition..

One more doubt I have ... how we can calculate the Table A, Table B, and risk table for Subsequent visit. Please help me on this...
 
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Two or more self-limited or minor problems with Rx drug management

If it is Emergency department which level would you append?

As per guidelines Prescription drug management will go for moderate which leads to 99284?

Is it correct? Please suggest me.
 
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