sinman0531
Guru
I'm auditing documentation/reviewing insurance denials to see if they are eligible for appeal. We billed a 99213 for a patient with a diagnosis of HS. Patient was seen 30 days prior and billed for an office visit then, which was paid.
This date of service the provider performed ILTAC injections into some of the lesions. The documentation for the "visit" is mostly cut-and-paste/automatically added by the EMR. The only original/unique documentation that has been added for this visit is:
"Flared today; worse with menses. Prescribed doxycycline 20mg PO to help with flares around menstrual cycle."
I'm conflicted as to whether that is truly enough to support a 99213 in light of also performing the 11900. If it were by itself, I would really advocate for a 99214.
This date of service the provider performed ILTAC injections into some of the lesions. The documentation for the "visit" is mostly cut-and-paste/automatically added by the EMR. The only original/unique documentation that has been added for this visit is:
"Flared today; worse with menses. Prescribed doxycycline 20mg PO to help with flares around menstrual cycle."
I'm conflicted as to whether that is truly enough to support a 99213 in light of also performing the 11900. If it were by itself, I would really advocate for a 99214.