AmyCPCCPCH
Networker
Hello everyone. I am having a problem with a provider who can dictate enough information for a level 5 but really for the problem it should be a level 3. The problem is, is that it is an established patient so the physician only needs 2 out of 3 components. He dicatates a great history and does a great exam so he gets his 2. His history and exam actually never changes. It is the same word for word for the last 2 months. Is there anything that says there has to be some type of medical necessity for that level or that many exams, he is seeing the patient every other week, even if he does have a comprehensive history and comprehensive exam documented. I have looked on Medicare's website and have not seen anything. I need more of a reason to deny these claims besides I know you have been copying the same note for the last two months your plan just says follow up as planned. I know the medical decision making is not being met. Thanks for your help.