Wiki permanent problem is chronic but which level?

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One chronic, stable problem is low for the PROBLEM level. Depending on severity, and status, "hearing loss" without further context could be straightfoward, low or moderate for the number and complexity of problems addressed.
RISK is "Risk of Complications and/or Morbidity or Mortality of Patient Management". Without knowing what the documented patient management options are, you cannot determine risk. These would all be possible potential treatments - ranging from straightfoward (level 2 OP) to high (level 5 OP).
An elective major surgery will correct the problem, and the patient is diabetic.
Ordered a hearing aid.
Prescribed a steroid taper.
Discussed that hearing loss is so minor, no treatment is needed.
ENT generalist refers patient to a specialist to discuss a potential surgery.
Discussed that a minor surgery is an option, but the risks outweigh the benefits and is not recommended at this time.
Recommended a white noise machine to mask the tinnitus.
 
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thank you.
follow up question: "Recommended a white noise machine to mask the tinnitus." With a chronic problem, would this be level 2 or 3?
 
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That example is the RISK of treatment. This is separate than the PROBLEM which you state is chronic.
The level of a chronic problem could be straightforward (level 2) if the chronic problem is minor or self-limited. Could be low (level 3) if stable. Could be moderate (level 4) if exacerbation, progression or side effects of treatment. Could be high (level 5) if severe exacerbation, progression, or side effects of treatment.

If the question is - what level of risk would I consider "recommend a white noise machine to mask the tinnitus"? I would have to consider that level 2 unless it was some special type of machine that is DME (if that even exists). A noise machine or app on your phone is very minimal risk.
 
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Thank you. So it's not enough to list or discuss treatment options like tinnitus masking. I'm finding a lot of borderline level 2/level 3 with a new provider and I feel it is time for provider education to clarify differences between levels 2 and 3.
New provider could note 20 minutes time for a level 3-established patient. Could also note that a discussion of hearing aids took place.
I'm still conflicted about whether we can count hearing tests (audio/tymp) discussions by MD or PA when our audiologist is billing 92567/92557 for audio/tymp. Like when MD/PA orders 2 separate tests and/or reviews audio/tympanometry test results.
Audiology has same tax id as ENT but is a subspeciality of ENT.
Any ideas?
 
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I think I got it. You are asking if the practice is billing 92567/92557 by the audiologist, can the physician count the order/review? It does kind of seem like a loophole if the audiologist is billing for the test. Clearly, if the physician is billing for the test, absolutely not able to count the order/review. Here's the AMA definition with my emphasis on the tricky part:
►The ordering and actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when the professional interpretation of those tests/studies is reported separately by the physician or other qualified health care professional reporting the E/M service. Tests that do not require separate interpretation (eg, tests that are results only) and are analyzed as part of MDM do not count as an independent interpretation, but may be counted as ordered or reviewed for selecting an MDM level. The performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The interpretation of the results of diagnostic tests/studies (ie, professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended.◄
In your example, the test/study is reported separately, but not by the physician/QHP reporting the E/M service as the clinicians are different specialties. This is not something I have seen a specific guidance on when different specialties regarding test ordering and performing. My personal advice would be to go to your specialty society for clarification. My initial interpretation is that it does feel like double dipping. However, I keep re-reading the definition, and the audiologist is not the physician/QHP reporting the E/M service. I'm certain every other ENT practice with audiologists billing is dealing with this as well, which is why your specialty society might be able to clarify.
 
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Thank you Christine. Very well composed answer. I am a member of FB Otolaryngology Group and have reached out. Various answers, but I cannot get confirmation anywhere that I can definitely count ordering 2 hearing tests ordered, when we are performing them 6 months after ordering them. (We bill 92557 and 92567 at the 6 month mark--when the 2 hearing tests are actually performed.) I have no confirmation yet that the hearing tests ordered 6 months prior can count towards 2 tests ordered on that same day of service.
 
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I would still recommend your specialty society. A FB group is great to get opinions. If you want official guidance, then go to the physician's specialty society. In my specialties, ACOG and AUGS will both accept questions and provide guidance for items related to their expertise. ACOG allows member physicians AND STAFF to submit questions. AUGS only allows members. You may need to ask one of your physicians to actually submit the question.
My impression is that it "feels like" cheating, even if it is technically allowed. Since the same practice is performing the test, I would NOT count it unless I had guidance stating it is allowed.
 
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