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Wiki Humana requirement for documenting Z79.4, long term insulin use

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cubbiecatz

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We just had an audit from Humana and are being told that the doctors note is not sufficient unless it states the plan is to continue insulin, increase or decrease the dosage.

We had a visit where the doctor mentioned in HPI patient was on insulin and Victoza. In the Assessment and Plan the doctor noted patient is on 4 units of Lantus and Victoza. Humana is counting that as wrong because in the A&P the doctor did not state to continue the insulin. My argument is that the doctor did not note to stop the insulin. I think his documentation was fine and I know how it will go over to tell the doctors they must state the continued plan for insulin.

Any thoughts?

Thank you, Cathy S, CPC, COBGC
 
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