Wiki Pre-op HPI

SamanthaM

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:confused: Our office recently had an auditor look at charts and she mentioned that there should only be one bullet under the pre-op HPI...I have never heard this before and it doesn't seem right...can anyone confirm or help me out. Our Medical Director would like to know if this is true or not so that he can adjust our EHR templates if needed.
 
Actually, I'm not sure what she was looking for...I was out on maternity leave when she came and did the audit. I just got back this week and our Medical Director came to me asking but he didn't give me specifics.

I'm thinking that she is incorrect because pre-op consults are coded the same way as regular E/M services now for Medicare, so they should be able to document more than one bullet in the HPI as they do for a regular office visit...if you know anything different please let me know.
 
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