Wiki number and complexity of problems/leveling e/m

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Korbc

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Hey guys
I know menopause isn't a chronic condition but if my practice is always treating peoples symptoms over longer periods of time with HRT, patches etc etc and i count it as a chronic condition or i have to just only code off the symptoms for the complexity of the problem?

and I'm an obgyn coder and was wondering if someone can give me advise if untreated BV, yeast, vulvitis etc would be conditions that could count towards high risk of morbidity if left untreated, I've seen it both ways online that it does and doesn't. Any opinions on that as well?

Thanks so much!
 
Symptomatic Menopause is a natural biological process that happens to all women. You are correct, when it comes to coding and medical decision making it would never be considered a chronic illness/condition. Yes, it is chronic in that it lasts for years and years but, it’s a natural process that every woman goes thru. Not a chronic condition like HTN or something of that nature that not everyone ends up with & can lead to life threating problems. If you do not treat the symptoms, it is highly unlikely the patient will end up in the hospital or death. The symptoms themselves I feel are minimal straightforward "call mom" kind of problems. But, if they were manageable/not getting in the way of life a person wouldn’t be seeking medical attention to try & ease the symptoms. Not all women seek medical care for symptoms because I assume while annoying, they are tolerable. So, it is possible that the symptoms could level out to acute uncomplicated.

BV, yeast, vulvitis etc in and of themselves would not level out to high risk of morbidity. However, they could lead to other serious complications which could be life threatening. I think of it like a regular ole UTI. Sure, left untreated it could cause sepsis but, presenting with symptomatic UTI at an office visit would only be acute uncomplicated.
 
thanks! so if symptoms for menopause were very bothersome and affecting their quality of life like no sleep from persistant hot flashes and all the other problems that come with it and they have already been seen and they before but coming in for exacerbated symptoms and to possibly adjust medication or try new medication then you would not considered that chronic illness with exacerbation with rx mgmt? just want to confirm. it would still be acute uncomplicated? :)
thanks!
 
Read your definitions of the Number and Complexity of Problems Addressed at the Encounter in the CPT book.
"Stable, chronic illness: A problem with an expected duration of at least one year or until the death of the patient."

My view is that it is up to the provider to indicate in their documentation as to the COPA. I feel in many cases it could be considered chronic, exacerbated. What if the patient has been going through the transition for 3 years, the medications they are on are no longer working, they have multiple different symptoms, they are now moving into the range of osteopenia, the provider is ordering 3+ labs, they order a DEXA, they change and adjust the prescription meds, they refer the patient to speak to psychotherapy, and tell them to f/u in 2-3 weeks? How is that not chronic, exacerbated (Mod) plus Mod/Mod for the other elements? That would be very different from someone who is doing well on their single med, no changes, they have improved symptoms, yet have also been going through the transition for 3 years.

It is always dependent on the documentation by the provider. There is no single black/white answer. It can even switch around for one patient from visit to visit I think.
Also, consider it is not always "natural" menopause, it could be surgical too. Which would be different.
 
amyjph said:
Read your definitions of the Number and Complexity of Problems Addressed at the Encounter in the CPT book.
"Stable, chronic illness: A problem with an expected duration of at least one year or until the death of the patient."

My view is that it is up to the provider to indicate in their documentation as to the COPA. I feel in many cases it could be considered chronic, exacerbated. What if the patient has been going through the transition for 3 years, the medications they are on are no longer working, they have multiple different symptoms, they are now moving into the range of osteopenia, the provider is ordering 3+ labs, they order a DEXA, they change and adjust the prescription meds, they refer the patient to speak to psychotherapy, and tell them to f/u in 2-3 weeks? How is that not chronic, exacerbated (Mod) plus Mod/Mod for the other elements? That would be very different from someone who is doing well on their single med, no changes, they have improved symptoms, yet have also been going through the transition for 3 years.

It is always dependent on the documentation by the provider. There is no single black/white answer. It can even switch around for one patient from visit to visit I think.
Also, consider it is not always "natural" menopause, it could be surgical too. Which would be different.
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Thanks! all good points! yes I'm not talking about someone who is doing fine on their meds specifically someone who has had this issue with managing the symptoms of their menopause for over a year and receiving medications adjustments and sometimes further lab work up
 
Korbc said:
Thanks! all good points! yes I'm not talking about someone who is doing fine on their meds specifically someone who has had this issue with managing the symptoms of their menopause for over a year and receiving medications adjustments and sometimes further lab work up
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What Amy is saying is all that has to be documented in some way on the date of service to provide and support the rationale of the provider's decision making. It can't be inferred.
 
rachaelwilleford said:
What Amy is saying is all that has to be documented in some way on the date of service to provide and support the rationale of the provider's decision making. It can't be inferred.
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correct, of course it has to be documented as always. :)i was presenting a problem that i was trying to get advice on leveling if those were the circumstances and documented as such, .....that it is an already established patient who has been dx'd with menopause for some time put on menopause meds, and the meds are not working for her and she has exacerbation of the symptoms and there is further rx mgmt/adjustment
As always that would always need to be documented, I presumed that when i present a problem for advice that others know it is documented and I'm asking for the outcome of whatever the problem or question would be given that everything i need is documented.
thanks!
 
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