baroquecoder
Networker
I am being told that validating E/M's to some extent is beyond my purview.
Specifically medical necessity. I am being told that it is beyond my scope to recognize/question/or
validate E/Ms with regard to their medical necessity. I am being told that we are to 'assume' that
if the MD states in the impression a particular condition, that the condition was addressed, whether
or not present in ROS/EXAM components or HPI. This goes against my understanding of ICD-10 coding
for outpatient claims. I only code what was treated and/or relevant to that episode of care, everything else,
if not managed, evaluated, assessed and/or treated is not reported or relevant. Wouldn't this ultimately
affect the level of MDM or the level of E/M? I'm feeling a bit conflicted this morning about what elements of
the E/M I'm allowed within my scope to validate/question/confirm/clarify and code based on my credentials
and job description. I am a CCS, CPC and CCC. I intend to also be a CEMC very soon!
Specifically medical necessity. I am being told that it is beyond my scope to recognize/question/or
validate E/Ms with regard to their medical necessity. I am being told that we are to 'assume' that
if the MD states in the impression a particular condition, that the condition was addressed, whether
or not present in ROS/EXAM components or HPI. This goes against my understanding of ICD-10 coding
for outpatient claims. I only code what was treated and/or relevant to that episode of care, everything else,
if not managed, evaluated, assessed and/or treated is not reported or relevant. Wouldn't this ultimately
affect the level of MDM or the level of E/M? I'm feeling a bit conflicted this morning about what elements of
the E/M I'm allowed within my scope to validate/question/confirm/clarify and code based on my credentials
and job description. I am a CCS, CPC and CCC. I intend to also be a CEMC very soon!