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Need help regarding comp exam, PLEASE

  1. #1
    Phoenix, AZ
    Default Need help regarding comp exam, PLEASE
    Medical Coding Books
    Hello all:

    Our practice recently (last two months) has converted to EMR. With our conversion, I have been attempting to get my providers to stop documenting a comp exam for ALL patients. For example, patient arrives for test results for HTN, f/u visit for stress test, etc. Not all of my providers document a comp exam but a few are diehards and its easy to do now.

    I have taken my concerns to my practice manager and received a request for documentation regarding exam levels. I have read and re-read 1995 and 1997 guidelines and have copies to present. However, does anyone have anything more specific to exam levels? I also have a copy of the CPT nature of presenting problems but it does not specifically state what I need.

    Please help!
    Thanks in advance,
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  2. #2

    "Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a Current Procedural Terminology (CPT) code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed."

    Hope this helps

    Laura, CPC, CEMC

  3. #3
    Phoenix, AZ
    THANKS, Laura! I very much appreciate your help. I'm hoping that I have enough documentation for her.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  4. #4
    Central Pittsburgh
    I'm in full agreement. Medical necessity is the overriding factor.

    A stubbed toe on a healthy patient wouldn't warrant a comprehensive exam. However, a stubbed toe on a patient with circulations or diabetic issues may warrant such an exam.

    The documentation of the condition and unlying concerns is just as important as the details of the visit itself.


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