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New problem to the examiner

  1. #21
    North Carolina
    Medical Coding Books

    Thank you..... I value your opinion and was waiting to hear from you or someone with your background. I know this topic is not easy for some to digest but you really have to look at the big picture and all the components involved. You must have known what I was thinking when I posted my last question and you nailed it by stating...

    "If the two physicians were not in the same practice, even though the problem had already been diagnosed and treatment started, you'd still give Dr B the "new problem" points"

    That was the point I was trying to "drive home" but I was waiting for someone to open up the dialogue.

    Thanks again~
    Rebecca CPC, CPMA, CEMC

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  2. Default For Tessa :0)
    Hi Tessa,

    If you are out there, I'm sorry I'm one of those that needs additional digesting :0).

    So you have an established patient that comes in for a follow up lets say for psoriasis and saw provider A a month ago and they come back and see provider B for the same problem for a follow up to this "problem" would this be considered a "new problem" to provider B? Does it need to be documented by provider B that this is a "new problem" to them? Does this differ in each state? I am from Arizona.

    Many thanks in advance,


  3. #23
    Milwaukee WI
    Default I sent you a private message
    I really don't want to be getting into the nitty gritty of dissecting everyone's E/M notes.

    Use your judgement. In my experience most doctors do give you some clue as to whether they've seen this patient for this problem previously. If they haven't I give them credit for a new problem (unless it's "self-limited or minor")

    Okay, I'm done answering this question ...

    F Tessa Bartels, CPC, CPC-E/M

  4. Talking
    Quote Originally Posted by RebeccaWoodward* View Post
    I, too, agree...

    E/M University Coding Tip:

    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. (Do not get this confused with the 3 year rule..New versus Est. patient)
    Thanks Rebecca! I was trying to find a resource to help in a debate with a co-worker about this. Your link is very helpful!

    Amanda Kane, CPC, CPMA, CEMC, COBGC

    Keep Calm, We're Here to Help

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