Wiki Help!!! Self-Limited vs. New Problem??

[kristina.l.bennett@osfhealthcare.org]

I am trying to distinguish between a Self-Limited or New Problem on the MDM score sheet under the Number of Diagnosis or Treatment options. If the provider sees a patient for sinusitis or OM and prescribes medication, is this a minor problem worth 1 point or would it be a new problem to examiner with no additional workup for 3 points? What types of conditions would be considered Self-Limited/minor vs. New?

 

[jonique.dietzen]

If the condition requires prescription drug management, I would call it a new problem.

Self-limited, minor problems are those that do not really require medical intervention (eg. a rash that is already resolving, a runny nose without infection). Sometimes self-limited problems will include over the counter medications, but as soon as a prescription is required, it's no longer minor.

Jonique Dietzen, CPC, Project Manager