I work in the Medicare Operations/Risk Adjustment department of a major health insurance company as a coding auditor. Per CMS guidelines, Old MI (412) is allowable from pmh only. In the case of chronic conditions (ie, DM or COPD), in order to "capture" these codes for this DOS, the condition must be addressed during the course of the visit. For example: COPD is listed in pmh but not the A or P. Search the office note. Is the patient on medication specifically for COPD and the physicians notes the continued use and daily dosage? Did the physician listen to the lungs and make note of findings? Even if no s/s of COPD are present...the fact the physician addressed the respiratory system is enough to justify an evaluation of the status of the COPD.
So...only Old MI can be taken from pmh only. All other chronic conditions must be addressed in some way during the visit in order for the code to be included for that DOS.
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