Moderate MDM

sauls

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I see that sinsitis falls under a moderate MDM( if an Rx is writen), and becuase it is a new presenting problem ( 3 points). where can I find documentation that specifically shows that a NEW condition (such as sinusitis) is awarded 3 points?

I am located in VA, Trailblazers is our CMS admin. their EM coding pocket card does not say anywhere that a new condition is valid 3 point under the number of Dx's. are this type of visits normally a level 99214? assuming that it is for an otherwise healthy person?
 

rthames052006

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I see that sinsitis falls under a moderate MDM( if an Rx is writen), and becuase it is a new presenting problem ( 3 points). where can I find documentation that specifically shows that a NEW condition (such as sinusitis) is awarded 3 points?

I am located in VA, Trailblazers is our CMS admin. their EM coding pocket card does not say anywhere that a new condition is valid 3 point under the number of Dx's. are this type of visits normally a level 99214? assuming that it is for an otherwise healthy person?

I don't know if I'd consider sinusitis a new problem worth 3 points? I'd more consider it a self limited/minor problem based on it's natural course it will take. Does this patient have any co-morbidities? I'd be more willing to give it 1 point max...

Just my thoughts...
 

sauls

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Yes, that is an other way to see it, which is why I posted this. Some coders clasify it as being moderate MDM, because it is a New problem, other say it is self limited/minor. Who is correct? are we up coding or down coding? I believe Sinusitis would be low ( the defenitions are on the CPT book) but still not moderate.It makes me think We are coding to our own judgement, and an audit would be on some else's judgment, there no standards.
 
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Sinusitis is a new problem

Sinusitis will NOT just go away on its own (trust me, I know from personal experience). Of course, I am using this term only to refer to the kind of sinus infection that results in high fever, intense headache, obstructed nasal passages, and requires a 10-day course of antibiotics.

A cold, on the other hand, WILL go away on its own.

So on a first visit for a bout of sinusitis I would consider it a new problem. If the patient comes back a few days later for follow-up, then it is an established problem (hopefully, improved or stable).

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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