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Thread: MDM established problem (to examiner)

  1. #1
    Join Date
    Apr 2007

    Default MDM established problem (to examiner)

    AAPC: Back to School
    If a patient sees Dr A on Monday for knee pain, and then follows up with Dr. B due to worsening pain(both in the same practice), is this considered a new problem or an established problem? I believe that MDM states new problem to examiner.....

  2. #2

    Default it helps you

    Problems are defined relative to the examiner, not the patient. Even if the problem was previously known to other physicians or to the patient, it is still considered new to you if you are seeing the patient for the first time. This situation arises often in the case on consultations

    contact : grand_pcs@yahoo.co.in

  3. #3


    Is it still a new problem for physicians in same practice?

  4. #4
    Join Date
    Apr 2007


    I totally agree, I spoke to a group of physicians yesterday and explained that an establised patient is not the same as an established problem. I also explained the Dr. B would have the same amount of work for a worsening problem because they have not yet addressed this problem themselves. They must go through the work of determining the plan etc. Also have an answer to the question from WPS on this that agrees with us both. Thanks for your input.

  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default Payer specific

    Please be sure to get the specifics from your payer. Per emuniversity.com. at least one Medicare carrier defines an established problem as established to the patient.

    F Tessa Bartels, CPC, CEMC

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