Wiki What level of service?

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Tonyj

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Physician sees an established pt and documents 20 minutes spent with the pt. Bills a 99213 but the documentation warrants a 99215. Does time trump documentation?
 
No time is only a component. However you need to look at the patients diagnosis to see if it is consistent with level 5 service. CMS states that medical necessity (diagnosis) is the overarching criteria for a given visit level. The use of check box style templets lend themselves to creating high levels with little effort. So the question is just because the provider documents a level 5, SHOULD it be a level give the presenting issues.
 
mitchellde said:
No time is only a component. However you need to look at the patients diagnosis to see if it is consistent with level 5 service. CMS states that medical necessity (diagnosis) is the overarching criteria for a given visit level. The use of check box style templets lend themselves to creating high levels with little effort. So the question is just because the provider documents a level 5, SHOULD it be a level give the presenting issues.
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That's the problem. The patient has myelofibrosis, stable disease on a kinase inhibitor with symptomatic anemia, resolving headaches and constipation, returning for a blood transfusion.

The documentation dose support the level 5 but the physician documents 20 minutes spent with the patient and bills a level 3. Would this be considered under coding from an auditing perspective?
 
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