Industrial patient coding

eguest

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Do the rules for documentation apply to industrial patients? Our physicians normally code a higher level of E/M service simply based on the fact the patient is industrial. Their documentation and often times the medical necessity does not support the higher code selected. In the case of an audit, would a RATSTAT pick up industrial patients as well and they be included, or are they exempt? Thank you for your input. If there are official souces to quote that would be appreciated.
Elaine
 

eguest

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Industrial

Yes, I'm talking about Work Comp. RATSTAT is a softward program that randomly selects a sampling of patient records when an audit is conducted. Thank you for your assistance.
Elaine
 

jdrueppel

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Check your state's Work Comp website. I'm located in Nebraska and at the beginning of the fee schedule on the Disclaimer page it indicates they use AMA/CPT guidelines. Therefore, I believe, even industrial patient services have to coded in accordance with CPT guidelines.

Julie D, CPC
 
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