Problems Addressed

So, let’s review a few definitions before we begin. We’ll start off with problems addressed. Problem addressed is a problem that is addressed or managed when it is evaluated or treated at the encounter by the physician or other qualified healthcare professional reporting the service. This includes consideration or further testing or treatment that may not be elected by virtue of risk/benefit analysis or patient/parent/guardian/surrogate choice. Notation in the patient’s medical record that another professional is managing the problem without additional assessment or care coordination documented does not qualify as being ‘addressed’ or managed by the physician or other qualified healthcare professional reporting the service. Referral without evaluation (by history, exam, or diagnostic study[ies]) or consideration of treatment does not qualify as being addressed or managed by the physician or other qualified healthcare professional reporting the service. So, Dr. Cockrell if you could give us a few examples of what you would consider a problem.

Great Martiza. Let's talk about this problems addressed part of the element because it is important and as it turns out, these really need to be two separate and identifiable problems if you're going to use more than one. So, we all know the definition of a problem encompasses a lot of different things such as a disease, a condition, illness, injury, symptoms, sign, finding or complaint, but that isn't really the way that it's used in this particular context. So, we can’t have a patient that comes in with red, itchy, burning, purulent, exudate, and complaint, and call that multiple problems. We really kind of have to reverse-engineer a little bit from what our diagnosis is at the conclusion of the exam. So really, more than one problem might include glaucoma and diabetic retinopathy or glaucoma and diabetes. But then, as Maritza pointed out, did we actually address both of those problems? If we actually addressed both of those problems, we can move those into a different part of the grid on the slide and easily get into moderate. In the moderate level, so level four, and can be used that way. 

Let’s talk just a little bit about what it means to participate in the management of some of these issues, let’s say diabetes without retinopathy. Let’s say hypertension and maybe obesity even or smoking. How does the optometrist participate in that. It’s not that difficult if I’m going to take the time to discuss what the hemoglobin A1C is, what the fasting blood glucose is, and then I’m going to make recommendations with respect to exercise, with respect to nutrition, with respect to what we expect to see as the result of following those recommendations at our next visit. And then if we used that and then we had done maybe a glaucoma follow up at the same time. But we’re really seeing those patients on about the same interval, so maybe we’re seeing that diabetic patient every four months or every six months and we’re doing the glaucoma follow up really on the same schedule, we’re still addressing two problems. Now we can't see the patients' glaucoma follow up and note that they have diabetes and the only recommendation is follow up with your physician. That won't qualify as addressing two problems. However, being actively involved in the care of the diabetes does qualify you. And I have verified this with certified professional coders and certified professional auditors with cms which made sure understanding what is the separate on identifying a problem, what that truly entails. As I mentioned in the last slide, sometimes we need to reverse engineer from our diagnosis to end up with how many separate and identifiable problems we actually addressed. As I kind of mentioned, we might have bacterial or allergic conjunctivitis and we may have diabetes. We addressed both of those then we have two separate and identifiable problems. But the bacterial conjunctivitis, the patient may present with redness, puffiness, maybe some kind of exudate, or maceration of the eyelids, but it's still just one separate identifiable problem when we reverse engineer the issue based on our diagnosis. Same thing with allergic conjunctivitis or a viral conjunctivitis. If our diagnosis concludes that it's really the signs emanated from one problem, it's one problem.