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Chronic Conditions Listed in PMH

  1. #11
    Stuart, Florida
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    I had initially only sent the message to one person. When I didn't get a response, I went ahead and copied the message and pasted it in a lump message for a few of the most knowledgeable forum users. So if you got the message this morning, that was the second go around since I noticed that this thread was back at the top of the list this morning. The company that I work for allows us VERY limited use of the internet and I'm usually unable to pull up links for people that want "proof".

    That being said, thanks so much for your responses. My concern was this; even if a diagnosis is chronic and may affect the treatment of said patient, if the chronic condition is listed ONLY in past medical history with no treatment, monitoring, evaluating, etc etc addressed in the note, do you still code it because it is a chronic condition that COULD very well affect patient care?
    I've been told, no, you cannot assume that it holds bearing to patient care/ treatment and if it is written as HISTORY with no documented treatment, assessment, evaluation it must be coded as history.
    Vanessa Mier, CPC

  2. Default
    now I need clarification.

    Are you saying it is okay to code chronics from the "Chronic Conditions" and/or chronic conditions from the "PMH section" even if not addressed on that particular office note (DOS)?

    Thank you

  3. Default
    so are you saying the CMS guidelines does accept submission of chronic diagnoses when listed in "chronic conditions" and/or "PMH" sections of a note, even if hasn't been addressed for that particular (DOS)? That is is assumed?

  4. #14
    Stuart, Florida
    It is my understanding that "Chronic Conditions" is not the same thing as "PMH", aka PAST MEDICAL HISTORY. A good example of the point I'm trying to get across is this (I'm pulling this example from correspondence pertaining to this subject):

    Patient with well-controlled hypertension presents with signs/sx of some type of upper respiratory infection, including wheezing. The hypertension, controlled by XX medication, is noted in the past medical history. Provider determines that patient has asthmatic bronchitis, and prescribes antibiotics and an inhaler. Although the hypertension is not noted again in the assessment, you would code it as a secondary diagnosis, as it definitely affects what type of inhaler is prescribed.

    This I totally agree with. Let me explain why. Although the hypertension is included ONLY in the PMH portion of the note, it is addressed. By saying that the hypertension is controlled by said medication, you are addressing the diagnosis, thereby making it a pertinent problem.

    Now, if the note does NOT address the hypertension, meaning that Hypertension is written in PMH but no other information is given, I don't believe that hypertension should be coded. Again, let me explain why. How do we know that the hypertension has not gone away? Maybe the patient lost weight and no longer has hypertension, maybe by divine intervention the patient was cured!
    Vanessa Mier, CPC

  5. Default
    Past medical history is not exclusively of chronic conditions. But chronic conditions can be a part of the past history.
    In your example, though the HTN is a part of the Medical history, the type of previous condition has to be taken into account for treatment point of view for validating a safe drug prescription that do not affect/ aggravate or exacerbate that previous condition.
    But a patient with history of hysterectomy comes for pneumonia treatment. Hysterectomy has no bearing in the encounter or its treatment modalities..
    At the same time, a patient with aneurysmal clipping done a few years ago,(or even pacemaker), comes for a MRI diagnostic for the emergency department.. Would we give her the diagnostic MRI just because she is well and symptom free for a very long time?. NO, we would not opt for it because it has a great ill effect on the status of having a clip in the vessel. We would opt for CT rather than MRI.
    So, doesn’t the past history of a vascular clipping has great bearing over the present encounter.
    This is just a tip of an ice-burg and we have very many conditions medical/surgicalwhich have to be addressed to.
    Thank you Vanessa. I agree with you
    Last edited by preserene; 10-11-2010 at 03:27 PM.

  6. #16
    Greeley, Colorado
    I have been out ill, so I saw the PM this morning. I would not report a diagnosis code from PMH simply because it is do you know it is current? Now if it is listed under chronic conditions and affects the treatment of a patient then it could be reported. For example, a patient with DM presents with bronchitis - often prednisone is used, but prednisone will affect the DM so whatever treatment plan the physician decides to follow, the diabetes will have an affect on his/her decision. In a perfect world this train of thought would be clear in the documentation...but since this is not a perfect world (LOL) you can query your physician...
    Also, keep in mind that inpatient diagnosis reporting and outpatient diagnosis reporting guidelines are quite a bit different.
    This is a good topic of discussion and we will all learn something valuable here!
    Lisa Bledsoe, CPC, CPMA

  7. #17
    St. Louis West, MO
    Thanks, everyone, for the feedback. This is exactly the kind of discussion I wanted to get going.

    Responding to an earlier post, someone had indicated they don't write the guidelines, they only follow 'em. I, too, try to follow the ICD-9 Coding Guidelines, first and foremost. However, many times they are simply not clear. Ravirro had a good point - how can we ASSUME the PMH played into MDM on that DOS, especially with the EMR's autopopulating every condition the patient has had since the ingrown toenail they had as a fetus inutero?

    Lisa makes a good point, too. The inpatient and outpatient reporting guidelines are TONS different. The quote made on page 1 by eadun (although I can't see it right now because I'm typing this response) I believe is for the inpatient guidelines. The guidelines for physician offices are much different.

  8. #18
    Stuart, Florida
    Honestly, this was one of my favorite forum discussions. I'd have loved to have more coders involved to hear more opinions and facts on this topic. Like I said, I even privately messaged a number of members to incite response. Which, I'd like to thank those of you that responded! I agree, serhaug, though the guidelines may be printed in black ink on white paper, it is far from black and white. Much of coding has a grey area. Not to mention that, depending on what insurance carrier you're dealing with, they tend to have their own set of rules sometimes. Thank you, serhaug, as well, for posting such an interesting and relevant subject.
    Vanessa Mier, CPC

  9. #19
    Spokane, WA
    I too run into this issue. Pt is here (in the office) for symptoms of a UTI. Then, in the plan/ assessment, the current visit problems are dysuria, urinary frequency, HTN, Hypercholesterolemia, etc. No meds were prescribed during the visit. The HTN and cholesterol dx's appear to be lab related only for the next visit.

    I don't think those dx's should be counted towards the overall level of MDM. Other than the BP being taken during the vitals, no mention of either of the chronic conditions in the note, so no way to associate the chronic conditions to the treatment of today's complaint.

    any other points of view?

  10. Default Chronic conditions
    I disagree that chronic conditions can be reported just because it's noted in the PMH.

    Although coding guidelines state, "Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment", The documentation guidelines state, "The number of possible diagnoses and/or the number of management options that must be considered is based on the number and types of problems addressed during the encounter." Without the provider indicating that the problem is being addressed, as coders we should not assume.

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