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Pediatric Coding Alert

You Be the Coder:

Select Accurate Chief Complaint

Published on Tue Jan 13, 2015

Question: Our pediatrician documents most of his chief complaints as “follow-up” (for established patients) or “establish care” (for new patients). I have told him this is not a compliant chief complaint but he refuses to believe me. Who is right? Answer: It sounds like you are. If the notes said “Establish care and perform complete preventive physical” or “follow-up to otitis media [...]
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