Wiki DOS discrepancy and Correct coding

[y4zhill]

The following are all assuming that all other guidelines are met for correct coding, per CMS guidelines with a POS of outpatient.....

if there is one DOS on handwritten chart note and a different DOS on a dictated consultation and if there is something concrete that can link the two (transcription confirmation number)
then can use the DOS from the handwritten chart note for coding?
Or must both documents have the same (and correct) DOS before coding ….

Question 2 - if you add a third document that has the same DOS as the handwritten note (an order that corresponds/links the documents), could you then use the DOS from the handwritten chart note and order for coding? Or must ALL documents have the same (and correct) DOS?

Question 3 -
If there is a dictated OP report with DOS “x”
And there is a handwritten chart note with DOS “y”
And there is a linking confirmation number on both documents….
AND there are other physician/nurse documents that also show DOS “y” for the Op
Can we use the DOS from the handwritten post op note for coding?

*** resource information to back answers would be GREAT !!!

 

[Marybeth]

I would use the handwritten dos. There are many times that I have the dictated/authenticated dates that are not correct and all other dates confirm the handwritten dictation date. Hence, I always use the handwritten date. Hope this helps