Wiki Detailed exam on everyone!

chriskhans

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Local Chapter Officer
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Hooper, UT
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My providers do at least a detailed exam on every patient that comes into our office no matter what they are being seen for. This is excessive, and I don't feel right counting skin and/or musculoskeletal for someone who is just coming in for an asthma checkup.
Is it appropriate for me to NOT count these because they aren't necessary?

Thanks!
 
If the diagnosis does not support the exam and the provider does not provide any rational as to why certain things were examined then no it cannot be counted. CMS states that medical necessity is the overarching criteria for a visit level. While a detailed exam can be performed the question is SHOULD it have been performed given there sending problem.
 
Medical Necessity

If the diagnosis does not support the exam and the provider does not provide any rational as to why certain things were examined then no it cannot be counted. CMS states that medical necessity is the overarching criteria for a visit level. While a detailed exam can be performed the question is SHOULD it have been performed given there sending problem.

Hi Debra,

Could you tell me where I can find on CMS website about the medical necessity?

I would appreciate much. :)

Mary Diaz, CPC, CPC-I
 
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