History of Skin Cancer

Question:

If the patient is coming in for a skin examination and they have a history of skin cancer, is the complexity of the problem addressed low or moderate. We are having a debate in our office about this. The coders feel it is low when this is the only problem addressed but the doctors tell us the complexity is moderate since this is a chronic condition.

Answer:

Yes, a history of skin cancer is considered a chronic condition, but if there are not other problems addressed and the patient currently is doing well with no reoccurrence of skin cancer the complexity of the problem addressed is low. Based on the medical decision-making table for 2021, a chronic stable problem is low, but a chronic problem inadequately controlled, not at treatment goal, etc. is moderate. The coders are correct if this is the only problem addressed during the encounter the complexity of the problem is low. But keep in mind that this one of three elements. The amount and/or complexity of data to be reviewed/analyzed and risk are the other two elements to consider. Code selection is determined by two of three elements on the MDM table which must be met. This table can be found on: https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf.

*This response is based on the best information available as of 06/08/23.