sinman0531
Networker
I have a particular provider who is not a huge fan of documentation, and generally relies on his diagnoses and/or his prescriptions to justify billing a 99204/14 vs the 99203/13. According to all of the training he (and our other providers) have been given, anything Rx is going to fall under a "moderate" category, and OTC recommendations would be "low" complexity.
As a result, I have an EMN that he wants to send out with a 99204, with a lone Dx of L84 simply because he prescribed clobetasol 0.05% and urea 20%. I just cannot wrap my brain around any situation where topicals would make a callus a moderately complex issue. What am I missing? Or, how do I gently let him know he needs to consider not just the fact that he's writing a prescription, but the side effects and method of the Rx when looking at MDM?
As a result, I have an EMN that he wants to send out with a 99204, with a lone Dx of L84 simply because he prescribed clobetasol 0.05% and urea 20%. I just cannot wrap my brain around any situation where topicals would make a callus a moderately complex issue. What am I missing? Or, how do I gently let him know he needs to consider not just the fact that he's writing a prescription, but the side effects and method of the Rx when looking at MDM?