"Keeping it low" should not be a goal for coders - 'keeping it accurate', should. If the doctor did the work and documented it correctly, then they should be compensated fairly; but we should not try to make any encounter out to be greater than it actually was, for the sake of reimbursement. Although Medicare won't be adjudicating this claim (probably not any claim relating to infertility, really - I can't think of too many 65 year olds trying to get pregnant, but I'm sure they're out there...), the fact remains that commercial payers recognize and utilize CMS documentation guidelines in their payment policies, and their requirements are certainly not more forgiving. Coding a visit at a higher level just because CMS is never going to see it isn't a practice I'd recommend. Abusive billing practices are abusive billing practices, no matter which arena they're in.
To be perfectly clear, I'm talking about this encounter, not all encounters. I have no problem with doctors getting paid. But, if this patient came in for infertility, and the provider didn't document any counseling, or the amount of time spent in a discussion, or anything that suggested that their medical decision making had even the slightest degree of complexity, such as plans to find the cause of, or manage the infertility - then it would not be appropriate to assign a high level problem-oriented E/M, or a preventive E/M...even if most encounters for infertility usually warrant a higher level of service. Documentation requirements aren't arbitrary rules created to make doctors' jobs harder - they are designed to make sure that the minimum amount of information needed to understand the patient's problem, and the doctor's impressions and treatment plan for that problem, are recorded at every visit, in case someone else ever needs to know, and they're not around to ask. The only way to enforce those (perfectly reasonable) rules, is to link them to reimbursement. If the doctor feels that they should be paid more, then they should reflect that in their documentation, and not rely on coders to 'get creative' with their code assignments. It's part of their job, whether they like it or not; it's not our place to help them find a way to circumvent the system and get paid full price for only doing half of the work they're supposed to do. We're coders, not corporate tax attorneys.
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