When selecting the level of E/M service based upon medical decision-making, the best source of information is the Level of Medical Decision-Making Table. The table includes the four levels of medical decision making (ie, straightforward, low, moderate, high) and the three elements of medical decision making (ie, “number and complexity of problems addressed,” “amount and/or complexity of data reviewed and analyzed,” “and risk of complications and/or morbidity or mortality of patient management”). To qualify for a particular level of medical decision making, two of the three elements for that level of medical decision making must be met or exceeded. It is under “Number and/or Complexity of Problems Addressed” that the issue of acute versus chronic is addressed. Acute versus chronic is not based upon a “time frame.”
Acute vs. Chronic:
• 1. Stable chronic illness: A chronic stable problem is one with an expected duration of at least a year/death of patient; a patient at treatment goal is stable.
• 2. Acute, uncomplicated illness or injury: Acute, uncomplicated illness/injury is one that is a recent or new short-term problem with low risk of morbidity. There is little to no risk of mortality of treatment and full functional impairment is expected.
• 3. Chronic illnesses with exacerbation, progression, or side effects of treatment: Chronic exacerbated is one that is acutely worsening, poorly controlled or progressing with an intent to control progression and requiring additional supportive care or requiring attention to treatment for side effects, but that does not require consideration of hospital level of care.
• 4. Acute illness with systemic symptoms: Acute complicated illness with systemic symptoms has a high risk of morbidity without treatment.
• 5. Acute complicated injury: Acute complicated injury is one that requires treatment that includes evaluation of body systems that are not directly part of the injured organ, extensive injury, or treatment options are multiple and/or associated with risk or morbidity.
• 6. Chronic illnesses with severe exacerbation, progression, or side effects of treatment: Chronic illness with severe exacerbation includes progression or severe side effects of treatment that have significant risk of morbidity and may require hospital level of care.
• 7. Acute or Chronic illness that poses threat to life or bodily function: Acute/chronic that poses threat to life or bodily function soon without treatment.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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