We are having some issues with choosing the appropriate level of service for an established patient when performing an audit. We know that medical necessity is the driving force for any level of service, however we are having trouble when we run into a three way split. Here are two examples:
1. Physician documents a Comprehensive History, Detailed Exam and Straightfoward MDM.
2. Physician documents an EPF History, Detailed Exam and High MDM.
We are having trouble with which level of service would be appropriate and explaining this to our new coders when training on auditing. We have received advice from our current MAC on this, however our MAC is changing in September and we would like some outside opinions on this.
Any help would be appreciated.
1. Physician documents a Comprehensive History, Detailed Exam and Straightfoward MDM.
2. Physician documents an EPF History, Detailed Exam and High MDM.
We are having trouble with which level of service would be appropriate and explaining this to our new coders when training on auditing. We have received advice from our current MAC on this, however our MAC is changing in September and we would like some outside opinions on this.
Any help would be appreciated.