Wiki I had a recent denial for 96413 and documentation of direct supervision.

[Thweatt84]

Hello, Just had a recent denial for 96413 as no documentation of direct supervision was noted by the provider or in the medical records -- what are they looking for? The MD reviewed AM labs, adjusted the medications to be given - what is examples of direct supervision that they are looking for?
I understand The CMS definition of direct supervision is that " the physician must be immediately available, meaning physically present, interruptible and able to furnish assistance and direction throughout the performance of the procedure. The physician is not required to be present in the room during the procedure or within any other physical boundary as long as he or she is immediately available. " -- But how is that proven

 

[csperoni]

Was the chemo nurse's note signed by the physician? If not, maybe that is the problem.
Only the carrier could answer exactly what they are looking for. Perhaps they want a statement by the physician that they were present in the suite and available?? I've never seen that required, but you never know what a carrier will come up with.

 

[Thweatt84]

Was the chemo nurse's note signed by the physician? If not, maybe that is the problem.
Only the carrier could answer exactly what they are looking for. Perhaps they want a statement by the physician that they were present in the suite and available?? I've never seen that required, but you never know what a carrier will come up with.

Thank you for your reply, the individual infusion part is not signed by the physician - they are to do a final sign-off of the medical record. This was the first time we have had this ourselves - I have been doing payor audit appeals for the past 20 years.