Wiki New problem to patient or to provider

[wynonna]

Our patient saw one of our providers then switched to another provider with chronic rhinitis and acute sinusitis. Is either of these diagnoses new to our treating provider? (ie, how many points would these 2 dx be under number of diagnoses and management options)?
thank you

 

[DavitaBrannon03]

The problem as being new is relative to the provider. This scenario sounds like the pt is an established pt to the practice, but new to the 2nd provider that they switched to. All problems would be new to the 2nd provider during their initial visit while keeping in mind that an established pt E/M is the target code set. There would be 3-4 points given for Box A, depending on the documentation.

 

[katemae84]

I would consider them established problems, so either 1 or 2 pts for each under the "Number of Diagnoses or Treatment Options depending on their clinical stability, since the two providers are in the same specialty. The Medicare Administrative Contractor (NGS) for my region has clarified that scenario for us. Their position is:

"The reference to a problem as “new to examiner” is being changed to a problem as “new to patient”. This reference is changing to clarify the issue for same-specialty provider groups, many of whom have submitted questions on this issue. Providers in a same-specialty group are considered by CMS as one entity, and this concept applies in both the inpatient and outpatient setting. As such, a patient’s problem can only be “new” to members of a same-specialty group practice on one occasion, and is considered to be a known problem beyond initial presentation and documentation. If a problem has been recognized and addressed by one group provider, it is not considered new to another group provider who sees the patient on a subsequent basis. This is especially true because the first provider should have documented the problem, plan of approach and diagnostic findings, which should now be available to the second provider."