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Thread: Data Points

  1. #1

    Default Data Points

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    If a patient comes in with a breast lump and no new tests are ordered, but surgery is scheduled would this be considered a new problem with additional workup planned, or is it a new problem with no additional workup planned. Is only testing to determine the problem additional workup or is the surgery considered to be a workup if the diagnoses is known/unknown. We sometimes have lumps and bumps that the diagnoses is not confirmed until the surgery is done, and ok course we often know the diagnoses. My auditing sheet says that this area includes diagnoses or treatment options, and so I had assumed that this additional treatment option (surgery) would fall under the additional work up planned, but I recentlly saw a coding example that did not include this under the additional work-up. Of course, they usually order at least labs before most surgeries, but it is not to determine the dx it is for surgery requirements for the H & P.

    The example that I saw was a patient that was going to have hernia surgery. They labeled him a new patient with no additional followup. I considered the hernia surgery itself a new patient with additional workup. I had alway considered the surgery itself additional followup, and we usually bill the E & M charges before we know if they did pathology or found something different than the original dx. Would you only considered surgeries were pathology will be taken as a new patient with additional workup. Another example would be patients who have diverticulitis. We know their dx at the time of the colectomy, but pathology is always taken to check for cancer, and pathology is sometimes even taken during the hernia surgery. ty

    I can't find anything that details this info.

    Thanks for your help!

    Last edited by medicalsec; 10-17-2010 at 03:36 PM. Reason: add additional info

  2. #2


    I do not usually count this as work up. For work up, I look for labs and radiology. For Box C (Risk) I use the surgery to determine level of risk.


  3. #3


    Sorry, I really mean't to say problem points. If you had a breast lump or other lump or bump the dx is not fully determined until you perform surgery. If the surgery is diagnostic do you think that this would give a 4 in the problem points. Also, I read in the E & M University that they give problem points for systemic conditions diabetes etc. even if the surgeon is not treating the condition. Any thoughts?


    Last edited by medicalsec; 10-17-2010 at 07:19 PM. Reason: spelling

  4. #4
    Join Date
    Apr 2007
    Dover Seacoast New Hampshire


    No, a diagnostic surgery is not a diagnostic test, and is not considered "workup planned", in my opinion. I would give this three points for a new problem, and moderate risk for new problem with uncertain diagnosis.
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

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