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Self Limiting & Minor/ vs New Problem

  1. Default Self Limiting & Minor/ vs New Problem
    Medical Coding Books
    I would be interested in any comments, particularly those published somewhere, as to how to distinguish between diagnoses which are Self Limiting or minor versus New problems. I read somewhere recently that Self limiting or Minor problems are those which may resolve without medical intervention, problems which can be diagnosed by History & Physical alone (without any diagnostic studies) etc. This is opposed to New Problems which require some sort of work, x-rays, medical tests, lab studies, etc., to confirm a diagnosis. This makes sense to me. In one of Dr. Jensen's case of the week's recently, he gave credit for Otitis as a "New Problem". This seems excessive to me.
    CPT shows "earache in child treated by family doctor" as an example of a 99213.

    Any ideas?

  2. #2
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    You can use new problem and not necessarily have added workup.

    This all depends..is the patient new or established? After you have all the other elements to the audit, it may still only be a level 3. You have to consider the rest of the elements. He can have 3 points for new problem no added workup, but if the risk is low and he didnt review any work up, his MDM would only be a low anyways, even if his number of dx was a 3.

    Would really have to see all the note to decide what LOS would have been appropriate. Self limiting problems are minor ones like bug bites,cold,etc. A new problem is any problem that the doctor or one in his group has never seen/treated before.

  3. #3
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    1073358 writes: A new problem is any problem that the doctor or one in his group has never seen/treated before.

    That's the general idea, but too restrictive. A new problem is one that the patient is not currently (or at least not recently) being followed for. Otitis Media may be a "new problem" for the same patient more than once. For example: Patient seen with otitis media in Nov 2005. Same patient seen with otitis media in February 2009. It's not something that was being continuously followed; it appeared and resolved in 2005, now there's a new incidence of it.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
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    Quote Originally Posted by FTessaBartels View Post
    1073358 writes: A new problem is any problem that the doctor or one in his group has never seen/treated before.

    That's the general idea, but too restrictive. A new problem is one that the patient is not currently (or at least not recently) being followed for. Otitis Media may be a "new problem" for the same patient more than once. For example: Patient seen with otitis media in Nov 2005. Same patient seen with otitis media in February 2009. It's not something that was being continuously followed; it appeared and resolved in 2005, now there's a new incidence of it.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Good point...

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