Wiki Pain Mgmnt/Comprehensive Exam

[mmunoz21]

Hi,

Does anyone have an idea of what constitutes a "Comprehensive Exam" for pain management specialty? Looking at '95 CMS guidelines a comprehensive exam=8 organ systems exam (why would a pain mgmnt Dr have to do all other systems not involved?) ....

 

[jdrueppel]

Ok, I'll bite. I guess my response is..... you shouldn't bill a comprehensive visit because you can, you should bill it because it's medically necessary in order for your provider to determine a treatment plan or render an opinion. Simply because there's an abundance of documentation does not constitute medical necessity. I hope you don't take offense to my frankness.

Julie, CPC

 

[mmunoz21]

No offense taken, I'm auditing the records, I do not do the coding... The physician is arguing that his exams "in his eyes" are Comprehensive... but if you go by '95 guidelines he would have to examine 8 organ systems, which he feels is crazy since he has no business checking those other systems that are not related to the issue, and I'm glad he is not doing that.....

 

[jdrueppel]

How much time is the provider actually spending with the patient? It's hard to say but if the provider is also considering time spent with patient to increase the level of service (since exam documentation is not meeting that level) then maybe you should look at prolonged services 99354-99357.

Julie, CPC