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Define self-limited or minor problem for MDM

  1. #1
    Default Define self-limited or minor problem for MDM
    Medical Coding Books
    What constitutes a self-limited or minor problem in deciding Medical Decision Making for E&M services?

  2. #2
    The examples they give are cold, insect bite, tinea corporis. I have had several coding educators, some of them physicians, explain self limited or minor as a problem that will go away on their own without treatment. I have also had a doctor use the example of, if it makes him want to ask the patient "You came in here for that???" it is probably under this category.

    Hope this helps,

    Laura, CPC

  3. Default
    Does that mean if it is a new problem and a prescription is given (otc or Rx), then it is no longer self limiting, but a new problem w/o additional workup planned?


  4. #4
    Milwaukee WI
    Default Well ...
    Well, just because some patients won't leave the office without an Rx doesn't mean the problem isn't still "self-limiting." I'd especially consider this when the Rx is for something readily available OTC (Ibuprofen for example).

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 01-22-2009 at 02:24 PM.

  5. Default
    The patient reports to the clinic with concerns about itchiness of the scalp. This onset roughly three days after having her hair dyed. It is slowly getting better, however, the patient is still in a fair amount of discomfort due to her itchiness. Since this onset there has been no treatment for it. The remainder or the past medical history, family history, social history and a complete review of systems has been reviewed and noted in the chart.

    Objective: On exam, the patient a well appearing female, alert and oriented. Skin examination of the head and neck reveal erythema only in the areas of the scalp. There is no scarring nor alopecia in the area. The remainder of the patient's skin exam in unremarkable.

    Assessment/Plan: Contact dermatitis. The patient was advised to notify her cosetologist and determine which other products may be appropriate for her. She was given samples of Clobetasol (prescription) to apply to the scalp once a day before bed to see if this is helpful in resolving her condition more rapidly.

    We code on 95 guidelines, what do you get for this established patient visit?



  6. #6
    Milwaukee WI
    Default 99212

    F Tessa Bartels, CPC, CEMC

  7. Default
    Thank you Tessa, I thought the same thing!

    Exam = 2 body areas


    Self limited or minor problem = 1 problem point

    Risk = moderate prescription drug mgmt

    Amount of data reviewed = 0


  8. #8
    Jacksonville, FL River City Chapter
    Regarding the original topic, this is what the CPT book says:

    "Self-limited or minor: A problem that runs a definite and prescribed course, is transient in nature, and is not likely to permanently alter health status OR has a good prognosis with management/compliance."

    Since that is as clear as mud and can easily apply to more serious problems that many would have no problem labeling as "new problems," I usually add what has been posted already in my instruction, that "self-limited" refers to a problem that will usually self-resolve in a few days and really doesn't need medical intervention at all.

    Also, here is what one Medicare contractor said:

    "Follow-up Questions from the 8/23/06 E&M MDM/PROBE FINDINGS 99214 & 99215 TELECONFERECE with WPS Medicare.

    Q) Some of my staff attended a seminar earlier this year and asked for a definition of self-limiting or minor problem vs. a new problem. They stated that someone from WPS said if it required a prescription it's considered a new problem. Is that true?

    ANSWER: If a prescription is needed to manage a problem, it is usually not self limited. However, there are some self-limiting problems that will resolve themselves, but a drug is prescribed to help treat symptoms. In the end, the nature of the presenting problem and the diagnosis will determine whether the problem is minor or self limiting."

    Seth Canterbury, CPC, ACS-EM
    Last edited by SCanterbury; 01-28-2009 at 04:37 PM.

  9. #9
    North Carolina
    Well Seth...It's good to see you here. I was hoping you were going to answer one of my questions on the Part B List Serve today. Good to have you aboard.
    Rebecca CPC, CPMA, CEMC

    Your click COUNTS...

    CLICK to give FREE mammograms!

  10. #10
    Jacksonville, FL River City Chapter
    Thanks very much. I'll probably only visit this board sporadically--only have so much time.

    Seth Canterbury, CPC, ACS-EM

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