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Posts: 2
Reply with quote  #1 
Can a provider who does not treat a problem get the credit in the MDM for a diagnosis?  For example, my provider sees a patient who has a left foot ulcer and a right foot ulcer.  Both are mentioned in the HPI, exam and there are diagnoses for both.  However, the provider is only treating the right foot.  Another provider is treating the left leg/foot with a planned BKA.  There was a procedure done on the right foot, so no E/M for that, but I'm wondering if there can be an E/M for the left foot, a 99212, if this provider isn't the treating physician.  My facility requires 1 of the 2/3 key components be the MDM.

Posts: 33
Reply with quote  #2 
No, he can't.

If he isn't treating the condition, how and why does it add to the complexity of medical decision making for that visit?

If a patient cuts their finger and goes in for treatment of the cut and has all these other conditions, such as diabetes, COPD, CHF, angina, etc....but NONE of them are addressed or treated, it doesn't make the visit more complicated. 

You could consider diabetes and the ulcer as 2 conditions (even though it's only one code).  Unfortunately, we can only "manipulate" the information so much and if they don't meet criteria for higher E/M codes, they just don't meet it.  That's where physician education is important.

Educate them on why they aren't getting a certain level. "You didn't hit a 99213 because there's no complexity of care documented.  You treated only diabetes, no labs were ordered, no other tests, so MDM is lo and you didn't provide an evaluative statement on the other chronic conditions".  
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