Question Payment reduction from WC Hartford need help

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Location
Portland , OR
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we billed CPT 99203
claim was not paid to the expected fee schedule reason as shown below
- the documentation doesn't support the level of service billed. reimbursement was made for a code that is supported by the description and documentation submitted with the billing.
- the submitted documentation for a new patient , 9202-99205, did not meet the three components lacking in the level of history and exam for the code billed.
- claim / service denied / reduced because new patient qualifications were not met .

im not sure what need to be entry in the chart note so payer pay . below is the chart note .


Chief Complaint: cat bite 11/13/19

History of Present Illness: RHD patient sustained 4 puncture wounds to left hand today at work. She is a vet tech. She irrigated wound and cleansed at work prior to here. No loss of sensation or function. She is unsure of Tdap status - may be - she will check with PCP.

Review of Systems:
General:

Denies Apparent Distress
Lymphatic:
Denies Enlarged Lymph Node - Local and Tender Lymph Node
Musculoskeletal:
Denies Decreased Range of Motion , Joint Redness , Joint Swelling and Muscle Weakness
Neurological:
Denies Focal Neurological Symptoms
Respiratory:
Denies Fever
Skin:
Admits Rash
Positive puncture wound

Vital Signs:
Weight 290 lbs Height 5' 2'', BMI 53.03 kg/m sq, Category Extremely Obese, Temp 98.30 F, Pulse 99 b/m , Respiration 14 b/m, SAO2 99% Taken on Nov 13, 2019 at 7:54 PM by Ms Gianotti, Alyssa

Allergies:
NKDA

Current Medications:
Patient currently takes no medication

Physical Exam:
Constitutional

Appearance: No distress, Alert and oriented x 3
Cardiovascular

Radial pulses intact and equal.
Musculoskeletal

Left hand with full ROM - including thumb and fingers. Full strength with thumb extension flexion. Full pincer strength. No laxity with UCL.
Skin and Subcutaneous Tissue

Four puncture wounds left hand base of thumb. No active bleeding. No erythema or discharge.
Neurologic
Gait and Station: Ambulatory
Psychiatric
Judgment and Insight: Appears appropriate; Mood and Affect: Affect appropriate


Assessment And Plan: She sustained a cat bite at work - cat UTD on immunizations. She will follow up in 3 days. She is resistant to Tdap as may be up to date - will check. I advise Tdap update. She understands risks with animal bite and possible tetanus exposure. Augmentin for prophylaxis. She will recheck in 3 days.


Diagnoses:
Puncture wound without foreign body of left hand, initial encounter - S61.432A
Bitten by cat, initial encounter - W55.01XA

Prescription:
Augmentin 500-125 MG Oral Tablet: 1 tab po TID x 5 days., Start 11/13/2019, Qty 15 Tablet(s) For 5 Day(s
 

AaPe12

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If they downcoded it to a 99202, I would tend to agree with their conclusion, at least through the lens of CMS DG; the PE does not seem to be a detailed exam.
 
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