Wiki DX Complexity Audits

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Sarahp941

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I posted this on the Diagnosis forum as well, but thought maybe I would get an auditors point of view as well. If this question doesn't belong here, I will delete. Thanks!

I have 2 questions regarding AKs. I just want to be sure I am understanding the new guidelines and not just having my Providers say everything is now chronic and surprise- 99214 visit. How are auditors assessing documentation if a Provider classifies a diagnosis being chronic but the AMA verbiage does not match? Is an auditor questioning the Provider to have them clarify why they felt the dx was chronic?

Actinic Damage - A Provider wants to classify Actinic Damage as "chronic" whenever a patient has AKs. Their logic is that they go hand in hand being chronic, which also conveniently populates a 99214, for having 2 chronic conditions. I know they are classifying this differently (now) because they are no longer getting 99214 for FBSE or AK focused visits. Actinic damage has no MDM, only counseling to wear sunscreen, which (to me) makes it a non-active dx.

AKs - Patient comes in once a year for FBSE. LN2 for AKs. Provider wants to classify this as chronic since dx has been present over 1 year.
 
Hi,
The MDM is not just the presenting problems addressed. They can consider the diagnosis to be chronic and have 2 chronic conditions but if there is no data and minimal (monitoring) or low (over the counter) risk then you are looking at a level 2 or 3.
AMA did release the definitions of the diagnosis classifications and they do state a chronic condition is something that lasts a year or more (in part). I struggled with this as well because to me, something like dry eye syndrome was very self limited but now falls under chronic. The codes work out in the end though because the risk is usually minimal to low and little to no data.
Hope that helps!
 
Thank you for your advice! And yes @saddie2k, what was once before, is not now. I think the issue I am struggling with is how Providers change their classification when they are attempting to get a 99214. On one patient they might call it chronic because they already achieved a 99214 from other factors. But then when you have a focused visit that would not be a 99214, then they call it chronic and they get a 99214 with prescription. I just wanted to be sure I truly understood in case of audits - which are a higher chance this year. I think I will have them document a little blurb to support their reasoning for complexity, for those problem-focused visits.
 
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