Wiki HPI and Renal Patient

[medicalsec]

Our doctors never seem to meet the four HPI requirements on a patient that they are asked to do a procedure for dialyses purposes. I always have to down-grade to a hospital visit code rather than being able to bill 99221-99223 for a Medicare patient on a consultation request. They always discuss the fact that they were asked to do a graft, AV fistula, etc., but can't seem to discuss four of the required HPI's under this situation in order to bill higher than a hospital visit. I was wondering if anyone else encounters this with this kind of a situation. I am referring to location, severity, timing, etc.

Thanks,

Dee