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Number of Diagnosis or Treatment Options

  1. Default Number of Diagnosis or Treatment Options
    Medical Coding Books
    Patient presents for >3 chronic or inactive(conditions), and provider gives status of each condition being stable. When it comes to auditing and determining the number of diagnosis or treatment options, how are they counted?

    From a previous seminar we were told that we max out at 2 (self-limited or minor.) Shouldn't we credit for each chronic condition? For example, three chronics which are all stable = Est. problem(to exmainer);stable improved, 3 x 1=3 points.


  2. #2
    Default
    You would max out at 2, but you would get a high MDM, so that might help.

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default How would you get High MDM?
    If you are maxing out at 2 problem points, I don't see how you can get High MDM.

    Even if you have 4 data points (not sure how you'd get this either if everything is stable),
    I can't assume high risk here.

    "Two or More Stable Chronic Illnesses" is considered moderate risk.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Answering original question
    When counting problem points here are your options.

    Self-limited or minor problem (stable, improved or worsening) = 1 point (MAX 2 points)

    Establish problem, stable or improved = 1 point (x # of problems)

    Establish problem, worsening = 2 points (x # of problems)

    New problem; no additional work-up = 3 points (MAX 3 points)

    New problem; additional work-up planned = 4 points

    You have three chronic conditions which are stable. Each is worth 1 point, so you have 3 problem points.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Default
    Oops, Tessa is right. I forgot that it started out as three chronic problems. Sorry about that. Also, I didn't realize that you can use 2 points for every problem. I always thought it maxed out at two, so thanks Tessa!

  6. Default New Problem in Number of Diagnosis or Treatment Options
    Dear F Tessa Bartels,
    Thank you for Posting about Number of diagnosis, that article is very helpful to us, but i'm getting little bit confusion about New Problem(to examiner)no additional/additional work up.
    what the doubt is how can i consider the Number of Diagnosis in New problem. means should i consider minor/self limited problems or Chronic conditions.
    Last edited by gkkvsn; 01-20-2017 at 03:43 AM.

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