Caveat Rule

preeti89

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Vadodoara, N
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Hi all,
Today i got one chart in this patient is New and addmitted in hospital. He having medicare insurance.
Patient is traumatic having severe fractures and admitted in iCU. But physical exam is not support for comprehensive. As it is medicare insurance can we down code it or we follow caveat rule as nature of presenting problem is high


Is medicare follows Caveat rule or not.

Kinldy reply ASAP.


Preeti verma CPC
 

tjbd57

Contributor
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Location
Savannah, TN
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Caveat

Preeti,
My suggestion is to search on your MAC's website for the caveat guidelines they have. Usually it is depending upon the documentation the provider gives as to "why" the exam cannot be performed or performed completely if you can justify a caveat of the exam. You should be able to find the information you need from there. Hope this helps somewhat:)
 
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