Wiki Electronic Medical Records/Upcoding

mmunoz21

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Valrico, FL
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Hi,

EMR's are becoming more and more prevalent.. In auditing these records they almost always score a level 4 or level 5 established office visit.. Comp. Hx., Extended or Comp. Exam, Moderate/High complexity...

I know that Medical Decision Making trumps all these nice EMR's and that Volume of documentation is not always medically necessary..How is everyone handling this out there? I look at Chief Complaint, then assesment/plan and determine what body areas/organs system needed to be looked at, I'm not an M.D., so how do we argue this with M.D..s?????????
 
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