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  1. #1
    Exclamation Pfsh
    Medical Coding Books
    When documenting the PFSH, in order to count towards the E/M visit, does the doctor need to sign off that he has reviewed this or is the nurse's documentation of it enough. In our office, the nurse fills out the form and initials it at the bottom. I need to know if my docs should be initialing it as well.
    Chrissy, CPC

  2. #2
    North Carolina
    My providers will normally make some type of statement such as..."PFSH reviewed and information is accurate".

    DG: The ROS and/or PFSH may be recorded by ancillary staff or on a form
    completed by the patient. To document that the physician reviewed the
    information, there must be a notation supplementing or confirming the
    information recorded by others.
    Rebecca CPC, CPMA, CEMC

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  3. #3
    Milwaukee WI
    Default MD must review to get credit
    The "history" form we ask patients to complete actually has a place for "provider review date / signature"

    We also instruct our physicians to add phrase in their dictation "For PFSH and ROS please see patient history form, completed dd/mm/yy and review by me this date." We ask them to note any pertinent positives or negatives, also.

    F Tessa Bartels, CPC, CPC-E/M

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