What, precisely, is a “self-limited” condition?

May 6, 2024

This issue is a continuing source of uncertainty for coders and providers alike, especially since we all analyze and apply information differently in medical decision making (MDM). So, how can we bring greater standardization (and compliance) to self-limited and minor conditions?

Let’s take a closer look at each.

Minor Problems
A minor problem typically does not require the presence of a physician or any extensive medical intervention. It might be as simple as checking blood pressure or recording a patient’s weight.

Self-Limited Conditions
A self-limited problem is different. It is a health issue, as defined by the AMA, “that runs a definite and prescribed course”—meaning it follows a predictable pattern—and is “transient in nature,” meaning that is temporary and is likely to resolve on its own without extensive medical intervention. Moreover—and this is important— a self-limited condition “is not likely to permanently alter health status.”¹

One example might be a patient suffering from a common cold with no underlying health conditions. The cold can be expected to follow a predictable pattern and resolve with only minor intervention.

MDM for These Conditions
So, how do you code for minor and self-limited conditions? Here’s some guidance from AAPC: A patient encounter involving one self-limited or minor problem should be a Level 2, while you should apply Level 3 to a visit addressing two or more self-limited or minor issues.²

Technically, all of the above descriptions are correct. And yet, for MDM leveling—and ensuring proper credit for services provided—they don’t necessarily give you the precise guidance that might be as helpful as a list of injuries and illnesses that would fit into the “minor” or “self-limited” category.

¹ Code and Guideline Changes | AMA (ama-assn.org)

² Determining MDM Complexity for E/M Leveling – AAPC Knowledge Center

With that in mind, here’s my best shot at such a list:

• Mosquito bite
• Viral illness
• Simple rash
• Follow-up on resolved issues
• Uncomplicated pharyngitis
• Uncomplicated cold
• Allergic rhinitis/ hay fever
• Minor abrasions

By no means is this an all-inclusive list. But at least it may help give you a better picture of what the AMA, AAPC, and others have in mind with their definitions.

Got a question about E/M coding? We’d love to hear from you. Submit your questions by emailing us at coders@calmwatersai.com

 

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