Wiki Medical Necessity

[sparkles1077]

Hello,

Just wanted to get some coding opinions on this one. Patient presents to a large multispecialty hospital based practice. Patient has an appointment with cardiology, but the appointment scheduler accidentally scheduled patient with orthopedics. Patient shows up to see orthopod who sees the patient anyway since they are there but patient has no orthopedic problems. Othopod bills a low level service for seeing the patient.

Would you question medical necessity and consider this unbillable?

Thank you

 

[mitchellde]

yes definitely not a billable service in my opinion. The big question is why did this visit go forward? Why wasn't this stopped when the patient or provider realized there was no reason for the patient to bee seen by ortho?

 

[MnTwins29]

Without the documentation, I would say no, it isn't billable. But did the patient tell the ortho doc about something else such as some knee pain? Yes, she may have been scheduled with cardio with whatever cardio issues she has, but was there another problem she had? "Oh, since I am seeing Dr. Ortho, might as well tell him about my knee pain." Something like that. Of course, there are still issues with this visit, but does the documentation of the visit by the ortho support the level and medical necessity.