Wiki Query dr for missing exam?

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GAcoder

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Is it correct to query doctor for missing exam 2-3 weeks after encounter. The dr sees hundred patients x day how, can they possibly remember exam to add to encounter at later date. Should I just down code these as soon as I get encounter?
 
I wonder why the vists are being coded 2-3 weeks later - can this process be changed for coding closer to the actual DOS? Also, the Dr may have hand written notes somewhere he can reference to. I don't think there's a guideline definining the time after a visit where an ammendment cannot be made. I struggle with this dillema too, but it's not up to us to determine whether the Dr actually does remember the exam or not. If the Dr decides he knows what happened on that DOS, then we need to believe him. Plus, if this is a common occurence, the feedback from you asking for the exam may help them in the future to actually document it at the time of service.
 
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