ttate
Networker
Does anyone have a link or know of a good resourse that explains when to count a problem as "self limiting/ minor" or as a "new problem to the examiner"? I have providers that can argue it either way.
ex: URI. normally it counts as a self limiting problem that will run it's course without the need for medical treatment. We all get colds and don't always need to go to the doctor. The problem I am running into is when the provider does rapid strep tests or writes a prescription. I have providers who argue that once they decide it is medically necessary to order those tests or write that prescription, it is no longer is a self limiting problem. That it required additional workup or treatment - (in essence, the nature of the problem changed and would no longer qualify as self limiting). They feel that it is considered an acute uncomplicated problem that is new to the provider...but my dilemma is that the MDM guidelines use a "cold" as an example of a self limiting problem. The additional workup of tests and/ or writing a RX would be counted in the "amount of data" and "risk" to the patient to get the overall MDM. How do you count situations like this?
ex: URI. normally it counts as a self limiting problem that will run it's course without the need for medical treatment. We all get colds and don't always need to go to the doctor. The problem I am running into is when the provider does rapid strep tests or writes a prescription. I have providers who argue that once they decide it is medically necessary to order those tests or write that prescription, it is no longer is a self limiting problem. That it required additional workup or treatment - (in essence, the nature of the problem changed and would no longer qualify as self limiting). They feel that it is considered an acute uncomplicated problem that is new to the provider...but my dilemma is that the MDM guidelines use a "cold" as an example of a self limiting problem. The additional workup of tests and/ or writing a RX would be counted in the "amount of data" and "risk" to the patient to get the overall MDM. How do you count situations like this?