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Can I count more than one dx?

  1. #1
    Default Can I count more than one dx?
    Exam Training Packages
    Let's say I have a patient who presents to a psychiatrist as a new patient. Provider dx's him with depression, anxiety, alcohol abuse, and drug abuse.
    If the provider states in his note that depression, anxiety and alcohol use are stable, can I give credit during as audit as follows:
    3 pts for the drug abuse (as a new problem to dr) and can I give 1pt for stable depression, 1 pt for stable anxiety, and 1 pt for stable alcohol?
    Or am I only allowed to claim one new problem (3 pts) and nothing else?

  2. Smile Counting Diagnoses
    You would use 3 for the drug abuse and since you only need 1 more point to reach Extensive in the final result for complexity you would not have to count all 3 stable diagnoses.Where the other diagnoses may be condsidered would be under Risk of Complications/or Morbidity/Mortality to reach Moderate risk with "Two or more stable chronic illnesses".

  3. Default
    Counting Diagnoses

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    You would use 3 for the drug abuse and since you only need 1 more point to reach Extensive in the final result for complexity you would not have to count all 3 stable diagnoses.Where the other diagnoses may be condsidered would be under Risk of Complications/or Morbidity/Mortality to reach Moderate risk with "Two or more stable chronic illnesses".

  4. #4
    Location
    Milwaukee WI
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    4,466
    Default Each problem is counted separately
    Well, your documentation doesn't really state that drug abuse is a new problem, so I'm not sure it warrents 3points.

    Each presenting problem is counted separately, BUT there is a limit on how many points you can get in a given encounter.

    There is a maximum of 3 points given for new problems without work-up. So 1 new problem or 4 new problems you only get 3 points.

    There is a maximum of 2 points given for stable, existing problems. So if you have 3 stable existing problems (each worth 1 point), you can only count a maxmimum of 2 points.

    It is important for the provider to clearly document whether a problem is existing or new. If not documented as new, an auditor will assume it is existing. (Except for new patient visits, where, by definition, all the problems are new.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 04-01-2010 at 04:53 PM.

  5. #5
    Default
    Quote Originally Posted by FTessaBartels View Post
    Well, your documentation doesn't really state that drug abuse is a new problem, so I'm not sure it warrents 3points.

    Each presenting problem is counted separately, BUT there is a limit on how many points you can get in a given encounter.

    There is a maximum of 3 points given for new problems without work-up. So 1 new problem or 4 new problems you only get 3 points.

    There is a maximum of 2 points given for stable, existing problems. So if you have 3 stable existing problems (each worth 1 point), you can only count a maxmimum of 2 points.

    It is important for the provider to clearly document whether a problem is existing or new. If not documented as new, an auditor will assume it is existing. (Except for new patient visits, where, by definition, all the problems are new.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC


    It would not matter if the patients drug abuse is established or new. When auditing the number of dx portion, you are auditing as new or estblished to the provider.

    With that said, that's my issue. My dr wants to be able to bill a 99245 or 99205 and I really don't see how it will ever happen. In most cases there won't be any added work up to count 4 for dx and he said he won't normally see the patient long enough to meet time criteria so I can't bill based on time in every case. But he is adament that some of his patients are the work of a level 5, even though I can't get him there in an audit for # of dx'x. The best I get is a 99204

  6. #6
    Location
    Milwaukee WI
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    4,466
    Default 1 new + 1 stable problem
    1 new problem without workup = 3 pt
    PLUS
    1 stable established problem = 1 pt

    Total is 4 problem points ... If you also have EITHER 4 data points -or- HIGH risk you have MDM that is High.

    And, Yes, I realize that the definition of the "new" problem means new to this provider. But your original post just lists 4 problems, without specifically mentioning that drug abuse is "new." If the provider (in the actual documentation of the visit) does not clearly identify a problem as new to him/her, then I, as an auditor, cannot give credit for it as a new problem. Remember, that each note must stand on its own. I'm not going to search the patient's entire record to see whether the problem appeared before.

    Sorry if I wasn't clear before. Hope that helps.

    F Tessa Bartels, CPC, CEMC

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