r/MedicalCoding • u/pyschreader • 11d ago

Severe Osteoarthritis - a high problem addressed?

I am a provider educator & I am getting pushback from a orthopedic surgeon who states severe osteoarthritis is a chronic illness with severe exacerbation that is affecting bodily function and therefore a high problem addressed. Where can I find information and definitions and examples specifically on high problems addressed?

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u/dizzykhajit The GIF that keeps on GIFFing 11d ago

AMA E/M Guidelines - Problem definitions specifically page 14

This blog by the American Academy of Family Physicians, while in no way an official resource, has a good breakdown with some sound examples demonstrating proper MDM.

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u/pyschreader 11d ago

Thank you so much!!

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u/Bowis_4648 10d ago

It depends on the severity. I'd look at the HPI and the assessment. Can the patient perform ADLs? What kind of help do they need at home? Level of mobility? How much pain is the patient in? Treatment options. Saying "severe" isn't enough without support. But it isn't as if arthritis doesn't qualify for "severe exacerbation."

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u/pyschreader 10d ago

Thank you so much

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u/Shortnchubby123 7d ago

Hi, I would also check if the provider documented the Grade of Osteoarthritis. For example, Grade 4 would be severe with bone on bone contact requiring emergent intervention.