Wiki HELP - -MDM Points - pt seeing different providers at same practice

[dappy]

We have multiple providers at different locations that all go under the same TAX ID and NPI. If a pt goes to see one provider for a condition then goes to another location seeing a different provider for the same condition - would you count this condition as a NEW problem for the second provider or an establish problem. Thanks

 

[Peter Davidyock]

I would count it as an established problem

 

[jvanek82]

We have multiple providers at different locations that all go under the same TAX ID and NPI. If a pt goes to see one provider for a condition then goes to another location seeing a different provider for the same condition - would you count this condition as a NEW problem for the second provider or an establish problem. Thanks

For MDM points, I would count this as a new problem for the second provider. I would suggest that this provider document that this is the first time they are seeing this patient for this problem. The description in the box under A says "new problem (to examiner)" and we were instructed by our Medicare carrier that this would be considered a new problem if the provider never saw the patient for this issue - regardless of it being the same provider group.

 

[Peter Davidyock]

The carriers I audit instruct that all providers in the same group are to be treated as a single entity. As such an established problem is an established problem no matter if Dr A, B or C is seeing them.

 

[annewhited]

cpc, cgic

I agree that if provider A sees patient and a week later patient sees provider B within that group it is a new problem to provider B and provider B should document that it is a new problem.

Thanks
Anne

 

[dappy]

Thank you for all the feedback.