If I were auditing this scenario I would consider to problem to be established.
Here's a question asked and the answer from an Ohio Medicare provider, PalmettoGBA.com
Must a condition be "new" to the patient or "new" to the provider in order for it to be consider a "new problem" when determining diagnosis/management options for scoring an E/M?
The term "new problem" is one that is identified yet undiagnosed and may or may not require an additional work up. A patient presenting to a new provider with a diagnosed problem is scored the same as presentation to a provider familiar with the patients problem. Therefore, for the purpose of scoring E/M documentation, a new problem is one that is new to the patient not to the provider.
This is the rule auditors in Ohio follow when scoring an established vs new problem.
- ICD-10 Training
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join