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Electronic Notes WITH handwritten notes

  1. #1
    Loma Linda- Murrieta Chapter
    Question Electronic Notes WITH handwritten notes
    Medical Coding Books
    Good Morning,
    I bellieve I was previously told that if a note is an Electronic Note, the physician could NOT write anything on it. For example; I have an EMR note that has the HPI handwritten and the rest of the note is electronically written and signed. Is that acceptable?

    I am not clear why this physician is doing that but will certainly inquire. In the meantime, before I complete his internal chart review, I need to find out if it is acceptable.

    Thank you,
    Debbie C

  2. Default
    Just wondering if there is a resource that indicates a provider can not write additional notes?

    Our providers do this all the time. This is because we have a regular EHR record, as well as a legal record which has more information and scanned documents. Another one of our practices uses paper charts, but will note in the paper chart to see dictation in EHR and we count both records towards the E and M.

    Diana, CPC
    Physician Auditor

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