Wiki new E/M guidelines and cataract evaluations

[cmmfeyen]

I'm wondering about the new E/M guidelines and how they seem to be affecting the cataract evaluations that my providers are doing. We used to always code a level 4 for a standard cataract evaluation, but now with the new E/M guidelines, it almost seems too easy to have these fall into a level 5. Under the number and complexity of problems addressed, with a High rating, the bullet point that says "1 acute or chronic illness or injury that poses a threat to life or bodily function" - per AAPC the definition of that can be "an acute illness with systemic symptoms; an acute, complicated injury; or a chronic illness or injury with exacerbation, progression, or side effects of treatment may be involved. This bolded portion is the same phrase that qualifies for a level 4, under moderate rating. Any help is much appreciated!!!

 

[saddie2k]

They still fall under level 4. Chronic condition with exacerbation is moderate and decision for major surgery w/out identified risk factors is also moderate. The surgery is non-emergent although there can occasionally be risk factors. High diagnosis complexity for chronic is with severe exacerbation. Hope that is helpful!

 

[Cheezum51]

I agree with saddie2k. Unless you had a cataract which had a major amount of progression from the prior visit (I'm talking going from 20/50 to HM), the problem really doesn't meet the level 5 problem definition IMHO.

Tom Cheezum, OD, CPC, COPC