dballard2004
True Blue
I am auditing one of my provider's charts and I am on the fence here and would like other's opinions please. This patient presented for a follow-up on two conditions and then also complains of sinus problems. The provider diagnoses the patient with sinusitis and thrush and prescribes two different antibiotics. Plus, he changed the medication on one of the chronic condtions.
Here is my problem.....clearly the MDM here is of the moderate level, but my history and exam only equate to EPF. The provider billed a 99214 for this encounter and I do see where the medical necessity would support that, but the history and exam doesn't.
Am I correct here that I would have to report 99213 based on ths history and exam even though the medical necessity would support 99214?
Just wanting to see how others would handle this. Thanks.
Here is my problem.....clearly the MDM here is of the moderate level, but my history and exam only equate to EPF. The provider billed a 99214 for this encounter and I do see where the medical necessity would support that, but the history and exam doesn't.
Am I correct here that I would have to report 99213 based on ths history and exam even though the medical necessity would support 99214?
Just wanting to see how others would handle this. Thanks.