For example, I just got a response from him regarding one of our patient's office encounters for doing 62368 and he insists on coding an additional 99214-25 regardless of the fact that his documentation doesn't seem to support it. The Chief Complaint is "Decrease Pump rate and discuss other options". The Assessments are: Encounter for adjustment and management of other implanted nervous system device [pain pump], Chronic Pain Syndrome (he also uses this for most of his patients), and Lumbar Radiculopathy.
The Plan lists that the pump was discussed with the patient and his wife, the patient wanted the procedure done ASAP, pump was decreased by provider's LPN under provider's supervision, clearance sent to pulmonology office and the procedure was done. There is a separate report for this which I've never seen before until they put the report in the patient's documents section of ECW. The rest of the documentation does not seem to address any other issues other than the one that the pump is being used for - the chronic lumbar radiculopathy.
For context, my job is to check the codes before the doctors lock their notes. And now this doctor has locked this note with the 62368 and 99214-25. He wrote me to say that the encounter needs it because he did not only look at the pump. I'm used to ECW automatically creating the associated claim overnight after the doctors lock their notes and then I'll change claims myself early the next morning before our biller submits them to insurance. I'm tempted to wait and see what happens with the claim once submitted to insurance before I change it to see if it gets denied and I can show the doctor then, but I'm also tempted to create the claim myself and change it there.
On the other hand, I'm always ready to admit that I'm wrong when I understand why I am wrong.
Anybody have any thoughts on this?
The Plan lists that the pump was discussed with the patient and his wife, the patient wanted the procedure done ASAP, pump was decreased by provider's LPN under provider's supervision, clearance sent to pulmonology office and the procedure was done. There is a separate report for this which I've never seen before until they put the report in the patient's documents section of ECW. The rest of the documentation does not seem to address any other issues other than the one that the pump is being used for - the chronic lumbar radiculopathy.
For context, my job is to check the codes before the doctors lock their notes. And now this doctor has locked this note with the 62368 and 99214-25. He wrote me to say that the encounter needs it because he did not only look at the pump. I'm used to ECW automatically creating the associated claim overnight after the doctors lock their notes and then I'll change claims myself early the next morning before our biller submits them to insurance. I'm tempted to wait and see what happens with the claim once submitted to insurance before I change it to see if it gets denied and I can show the doctor then, but I'm also tempted to create the claim myself and change it there.
On the other hand, I'm always ready to admit that I'm wrong when I understand why I am wrong.
Anybody have any thoughts on this?