Anna Weaver
Guest
We have a claim that rejected the protime for medical necessity from a visit in 2009. When we asked for the documentation to check for diagnosis, there is nothing there to indicate that a protime was done on that date. No dx will pass for medical necessity and can't find any way for this to pass. We contacted the office again, they said the patient was on chronic anticoagulation therapy. We told them there is nothing indicated on the chart on that date of service. They responded with a note that they have a separate sheet indicating patient problems and it's listed there and sent this to us. They also sent 2 previous office visits indicating anticoagulation therapy. None of these are referenced on the medical record for the date of service we need. The patient problem sheets are not signed by the physician. They have a flow sheet indicating date of service, dosage, lab date and result for that date of service, again not signed by the physician. They have a medication reconciliation sheet, again not signed by physician. Is any of this admissable for us without being referenced in some way in the record for that visit for that date of service? Can we go ahead with this protime charge from previous dates of service?
Any help would be greatly appreciated.
Thanks!
Any help would be greatly appreciated.
Thanks!