new problem vs established problem

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I have a nurse practitioner that saw a patient after their cardiac cath, diagnosis CAD. the np's supervising physician saw the patient the next day to discuss surgery options, same dx CAD. Would this be considered a new problem to the physician?

here is the assessment and plan by the NP- dos 08/17/16 ASSESSMENT AND PLAN:
A 64 year-old male with multivessel coronary artery disease. He is without symptoms of active chest pain or dyspnea. He will be evaluated by Dr. N. for possible coronary revascularization

this is the shorten version of the physicians assessment and plan-dos 08/18/16 a pleasant 64 year old male who has 2 vessel coronary artery disease. The patient was recommended to undergo coronary artery bypass grafting surgery

so for the medical decision making portion of e/m coding how would this fall under number of diagnosis or management options? new problem or established?

Thanks!
 

Chelle-Lynn

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If the patient was seen within the past 3 years in your office then it would be considered an established patient. In this case the patient was seen by the Nurse Practitioner the prior day, so the patient would no longer by considered new.
 
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this is not in regards to new vs established patient. This is about medical decision making and the diagnosis if it is considered a new problem or established problem.
 

Chelle-Lynn

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It would be considered an established issue. Same reasoning, the patient was seen for the issue the prior day and the credit for a new presenting problem would have been applied to that visit. The nurse practitioner is part of the same office and already rendered services for the same dx. The dx would now be considered established.

My apologies for the confusion on my last response.
 

mhstrauss

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I disagree, because of the verbiage "new problem to the examiner". If the physician had not seen the patient for the problem before, then at this visit, it's a new problem to him/her.
 

Chelle-Lynn

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With our ever growing medical practices we have so many levels of providers; doctors, physician assistants, nurse practitioners, etc. When using the phrase a "new problem to the examiner" we need to look at this from a more global point of view. The nurse practitioner works with/under the provider for the care of the patient. So when reviewing if the diagnosis is new to the examining provider the answer would be no, as the nurse practitioner had already identified this care as a new condition. The patient is being followed up with by the MD for additional consideration of the same diagnosis previously established in their office.

The doctor may be seeing the patient for the first time with the diagnosis, but the patient was seen and established with the diagnosis under the umbrella of general providers for the office.
 

Chelle-Lynn

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This definition was obtained a while back from Palmetto GBA. Since the physician is the supervising provider for the Nurse Practitioner, it is not new to the practitioner/examiner as they were supervising for the NP during the initial visit for that diagnosis.
 
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