Wiki Pain Score to Support High MDM Presenting Problem?

[cynthiakatherine]

Hello, EM folks! Question for you...what is your opinion about a pain score supporting High Presenting Problem? If a patient has a chronic condition with exacerbation, do you feel a pain score of at least 8 supports High Presenting Problem: chronic condition with SEVERE exacerbation? And have you seen any resources that address this? Thanks!

Cynthia Fike, CPC, CPMA

 

[amyjph]

Just going by that, I would want to see documentation within the note by the physician linking that to severe and/or stating it is chronic/severe along with something else in the note. Pain scores are subjective. The rest of the documentation would matter. They could be stable with a chronic condition and perceive their pain as an 8 all the time. I don't think one can just look at the pain scale and automatically assume if it is a certain #, just give it high COPA.
The resource would be the AMA CPT EM definitions for COPA https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
This is from ACEP for the ED but has good concepts if you look at the COPA bullets. https://www.acep.org/administration/reimbursement/reimbursement-faqs/2023-ed-em-guidelines-faqs
This is more talking about "severe pain" presentations in the ED but has good concepts too: https://www.acepnow.com/article/sev...,does not have an emergency medical condition.