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Wiki Assessment unrelated to CC and HPI

Thread starter neatmon
Start date Feb 26, 2010
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unrelated mdm

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neatmon

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Feb 26, 2010

Pt cc 7wks post c-section, painful incision; maybe a cyst on back of neck; frequent urination.
Assessment: Acute sinusitis. MDM has no relation to cc, and no addressing of final assessment in HPI, ROS, PFSH, or exam.
I'm thinking, that, without any MDM related to the cc or other areas, it would have to qualify for charging under time/consulting.
Pitiful documentation under traditional guidelines would disqualify this for any charge. Any comments are welcomed.

Thanks, folks

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