You Be the Coder:
Rely on Note for Reason for Partial History
Published on Tue Dec 09, 2014
Question: When we have an established patient that comes into our office that needs to be sent to the hospital, we don’t perform a complete review of systems. Will these be level 4 or 5 established patient office visits? Oregon Subscriber Answer: Determine the code selection by the visit’s documentation. You can give credit if a portion of the history was unable [...]