Forum - Questions & Answers

May 3rd, 2011 - SUEV

Problems managed elsewhere & mdm

If a patient who has issues that are being managed elsewhere is seen by their PCP, does the PCP get credit in the MDM for those issues? For example, an established pt comes in complaining of a cold. The MD notes in the History that the pt is being followed for CTS by their orthopedist and also is being seen by the pain clinic for their chronic pain which is worsening. In the assessment and plan, the pt is told to take OTC for the cold and under the CTS states f/u with ortho as planned and under chronic pain, f/u with pain clinic as planned. Since he has not changed anything and the patient's care for the specific problems are fully taken care of by the specialists, does the provider get credit for "managing" the problems in the MDM? If he doesn't, the nature of the presenting problem supports a 99212. If he gets credit for the additional issues being followed elsewhere, his level goes up to a 99214, which may be hard to explain to the patient when he asks why his visit cost so much for just a cold. Thank you for any opinions you may have on the subject!

Sue

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May 12th, 2011 - jschmutz   323 

re: PROBLEMS MANAGED ELSEWHERE & MDM

The other issues would have to contribute to the problem the physician is treating in order to count to the MDM. The visit you described would be a level 2.

If the patient came in with a cold, but also has an immunodeficiency disorder or has other issues that may complicate a cold then these would be used towards the MDM.

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