Wiki How to count chronic conditions in MDM for Pain management

[tatianapotter]

Hello!

I really need clarification on the problems addressed in MDM when the patient is being seen for their chronic pain management. When counting the # of chronic conditions addressed should we be counting it as 1 chronic condition which is the "pain being treated" in whole or should we account for each underlying condition and/or site of pain.

for example The patient has chronic low back pain from Lum Spondylosis and Bilateral knee pain from osteoarthritis that is stable on current treatment plan. Is this counted as 2 stable chronic conditions (spondylosis and osteoarthritis) or 1 stable chronic condition( chronic pain)?

seeing how we are specifically managing the Chronic pain I feel like chronic condition would be the chronic pain and would all be counted as 1 condition no matter how many sites of pain. Am I thinking about this correctly??

thanks

 

[bdcoyne8]

Hello!

I too work at a Pain Management clinic and based on the example you provided, I would count those as two chronic conditions.

Chronic Lumbar Spondyolosis as the low back pain is inherent
Osteoarthritis bilateral knee.

Osteoarthritis is considered a chronic condition on it's own.

G8929
M47816
M170

That is how I would code those conditions.

I think it will all depend on the way your providers document. If the patient has multiple chronic conditions our providers say something like "Patient presents with follow up for chronic pain which include low back pain, bilateral knee pain, right shoulder pain and right wrist pain". I would count all of those as chronic pains due to the way it is worded. Our providers are also very good about putting them specifically in the impressions.

1. Chronic low back pain
2. Chronic bilateral knee pain
3. Chronic right shoulder pain
4. Chronic right wrist pain
5. Acute left wrist pain

Hope this helps!

 

[tatianapotter]

Hello!

I too work at a Pain Management clinic and based on the example you provided, I would count those as two chronic conditions.

Chronic Lumbar Spondyolosis as the low back pain is inherent
Osteoarthritis bilateral knee.

Osteoarthritis is considered a chronic condition on it's own.

G8929
M47816
M170

That is how I would code those conditions.

I think it will all depend on the way your providers document. If the patient has multiple chronic conditions our providers say something like "Patient presents with follow up for chronic pain which include low back pain, bilateral knee pain, right shoulder pain and right wrist pain". I would count all of those as chronic pains due to the way it is worded. Our providers are also very good about putting them specifically in the impressions.

1. Chronic low back pain
2. Chronic bilateral knee pain
3. Chronic right shoulder pain
4. Chronic right wrist pain
5. Acute left wrist pain

Hope this helps!

are you often billing 99214's every routine visit for their prescription refill when they have 2 or more chronic pain conditions?

 

[bdcoyne8]

Yes, but we also feel we support the MDM based on the table of risk we were provided. 2 Stable chronic conditions with medication management. Specialties usually have a higher level of billing and are more in the curve for 99214s because they are a specialty. The prescriptions we provide are heavily monitored by the state and they are narcotics with risk of addiction so I feel they support those higher visits when prescribing things like opioids. Our providers are often treating more than one condition as well and document discussing injection therapies and "consideration" with risks and benefits also counts towards the minor procedure portion of the moderate MDM.

 

[jhean.marca@yahoo.com]

Yes, but we also feel we support the MDM based on the table of risk we were provided. 2 Stable chronic conditions with medication management. Specialties usually have a higher level of billing and are more in the curve for 99214s because they are a specialty. The prescriptions we provide are heavily monitored by the state and they are narcotics with risk of addiction so I feel they support those higher visits when prescribing things like opioids. Our providers are often treating more than one condition as well and document discussing injection therapies and "consideration" with risks and benefits also counts towards the minor procedure portion of the moderate MDM.

How about if per HPI pain is stable , and medications are controlling the pain better, then assessment and plan documented is 2 chronic illness with drug prescription -opiod, is this still count as 99214? thank you