I have a provider that submits level 4 and 5 E/M codes on nearly every claim stating that he spent the relevant amount of time with the patient to support that level code. He adds the saying that more then 50% of his time was spent counseling or coordinating care for the patient. The rest of his documentation in the medical record is very vague. I want to deny the claims because to me the medical record does not meet the level of MDM to support that code and I don't believe that the "Medical Necessity" is met. Example, that patient came to follow-up on blood work test results, the provider states he spent 50 mins discussing the blood work but the lab reports are not included in the documentation to verify extensive findings that would warrant a 50 min review. How can I get around the documented time? Can I deny base on med nec.? Should the record show what elements of the exam equal up to the total time documented? HELP!