tci Part B Insider - 2006 Issue 1

COUNSELING: Document All Services Performed In Counseling Visit

If you don't hear back from the CERT contractor, you're probably in the clearIt's not just discharge management that requires documentation of time (see story, earlier in this issue). You also need to document time carefully if you're billing for counseling and coordination of care.If a visit is more than 50 percent counseling and coordination of care, you can determine the level based on the time spent, instead of history, physical exam and medical decision-making (MDM). But you should still document any history, exam and MDM that happened in the visit, HGS Administrators clarified in a frequently...

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