Question: One point of clarification I’ve wondered about. What defines the chronicity of the condition? Is it if it’s lasted more than one year already for the patient or is it if we know that it’s going to last more than a year even if it’s only lasted a few months? I was always working under the impression It had to already have been there for more than a year at least intermittently to be counted as chronic?
Answer: Well, let’s see where our sources lead us. According to the E/M guidelines in the CPT 2023 book, the definition of chronic is a problem with an expected duration of at least one year or until the death of the patient. According to the CDC, chronic diseases “are conditions that last 1 year or more and require ongoing medical attention to limit activities of daily living or both.” Depending on the condition, there may be other definitions or guidelines that also exist. The best practice would be for the physician/APP to document whether they consider the condition acute or chronic in the note, leaving no room for confusion. Hope this helps.
*NOTE: This response is current in February 2023. As guidelines and payor guidance may change, please be sure to check if it is still valid when you are reading this issue.
