Wiki New problem vs Established problem for inpatient visits

[Meohmommie8]

Would someone be able to clarify new vs established problem for an initial inpatient visit that may have multiple admissions for same condition? In otherwords, if a patient is a admitted week one for a condition and three weeks later is admitted again same facility same condition, is the problem considered new because it is a new admission or established worsening? How does the new patient 3-year rule apply (if at all) for inpatient services?

Thanks

 

[MnTwins29]

The 3 year rule does not apply to hospital inpatient admissions - each one is treated as "new" for lack of a better term. The rule applies to office and hospital outpatient services.

As for the new problem vs. established problem, even though it would be the same condition, it is still a new admission, considered a "new" problem (remember that it will still require at least a detailed history and exam to be coded with the initial inpatient codes) and the MDM is based on whether the problem is new to the provider. I am assuming that the physician admitting the patient on the second admission when the problem worsened is the same one. Depends on the documentation - I have often seen "patient X, who is familiar to me..." so that might be a clue. Also keep in mind that if the patient has multiple problems, the problem points add up, so you may get the maximum even if the physician is familiar with all of them.

Hope this helps.