Thanks, I think I've got it now. So the best way to approach straightforward vs new problem points may be if the patient never came in for treatment the problem would go away on it's own-- so give it 1 problem pt for self-limited (even if it's new). That would apply in this case of Fifth's disease.
Just a personal comment, when a patient comes in with a rash there are over 100 things it could be, those need to be considered before narrowing down the diagnosis. To me, it still feels like a new problem, but can understand the logic that makes the final judgement straightforward.
I tend to agree with Dr Jensen about OM being a new problem 3pts if antibiotics are prescribed. It's concerning that an auditor has the power to make a judgement like that simply because CMS hasn't written the rules out very well.
Here's the note and how it was scored at the bottom:
cc: "rash all over"
HPI: 10 year old male presents with skin rash. Duration: onset 3 days ago, getting worse Location: generalized rash, affecting head, trunk, and all 4 extremities Severity: mild "didn't hardly notice it" Assoc s/s: mild itching, no fevers, no congestion, no sore throat
ROS: no shortness of breath, no n/v/d, other systems reviewed and reported as negative
VS: 97.9 - 88 HR - resp 16 - 104/60- wt 88 lbs
General appearance: NAD, conversant
Eyes: conjunctiva clear, no ptosis
Ears: normal appearance external ear, EACs patent, and TMs pearly
Nose: external appearance of nose is normal, turbinates and mucus membranes are w/out erythema or congestion
Oral: no erythema of pharynx
Neck: non-tender, no cervical lymphadenopathy
Lungs: clear to auscultation, resps even and unlabored
Heart: RRR, no murmurs, no edema
Skin: macular confluent rash noted on trunk, extremities, and face. Bilateral cheeks are red. Skin is warm, dry, and non-tender to touch.
Psych: mood/affect normal
Assessment: Fifth's Disease
Plan: Mother reassured that virus will run it's course with no further intervention needed. He is no longer contagious and may return to school. May use OTC benadryl or other OTC antihistamine for any itching that may occur. F/up if rash worsens or fails to resolve.
Medical Decision Making:
Problem points: 1 (self-limited)
Data Points: 0
Level on Risk Table: low (OTC med)
SF level of MDM
History level met: detailed
Exam level met: detailed
MDM level: SF
Code: 99212 (based on MDM of presenting problem, which is our policy)
Thanks again for the help.