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procedure documentation

M

MargoR

Networker
Messages
41
Location
Weslaco, Texas
Advise...
Plastic surgeon documented bilateral breast implants with mastopexy, He states specifics on the right breast then states attention to the left breast. Procedure was repeated using 450 mL implants etc... see report highlighted in yellow.
Question is: Does his statement (documentation) on the left breast suffice? "procedure repeated"

1603367367893.png
 
Does it suffice? Not in my world.

Is it good practice? Again, not in my world.

Will the insurance deny if they audit? Depends on the insurance.

Will it hold up in a malpractice case? Depends on what happened and if it goes to jury.

Is there one single, simple answer? No.
 
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