Wiki Prostate Cancer Dx

[tori.a]

A high level problem as I understand it must be acute or chronic and pose a threat to life or bodily function in the near future without treatment. Would you automatically put a new diagnosis of prostate cancer here? I would think the documentation needs to specifically outline why the risk is so high for a commonly treatable cancer.

I have a provider insisting it will always be a high level problem when the pathology is positive. Thoughts?

 

[Papitha]

It cannot be always high level.

• Established Patient Follow-Up:
  For a patient with a known diagnosis of prostate cancer, a routine follow-up visit might be coded at a lower level (e.g., 99213-99215) if the visit involves routine monitoring, medication management, and minimal MDM.
• Consultation:
  If the patient requires a consultation for a specific issue, such as a change in treatment plan or a new symptom, the E/M level may be higher (e.g., 99242-99245).
• Urgent or Complex Cases:
  For patients with complex cases, such as those with metastatic disease or requiring aggressive treatment, the E/M level may be higher (e.g., 99232-99235).
  
  In summary, the E/M level for a patient with a known diagnosis of prostate cancer depends on the complexity of the case, the nature of the encounter, and the services provided. Thorough documentation and adherence to coding guidelines are crucial for accurate coding.