Hi Adam ~
Have you audited the E/M level for compliance? If there are no signs or symptoms - how are they achieving their comprehensive history? Also, what are they basing their MDM on? For my docs, if they just have liver and sun spots - no suspicous lesions - this does not rise above a LOW MDM with 2 or more self-limited/minor problems for a level 3 MDM. (I'm assuming when you state high level visit you are meaning a 99244?)
The next question is - refer vs consult. If PCP isnt asking for advise or opinion on specifice problems its just a new patient. Sending patients to derm for a full skin eval is a transfer of care.
We also have a form we fax to outside providers that specifically state consult or transfer of care and what advise they are seeking.
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