The action that the provider's office need to take is that the provider's office need to review the codes and ensure sure they are the correct ones. The provider then need to inform the coder to do a lot of investigation on the code as well as also add a lot of details to all of the code.
The provider's office in the above case of the fracture need to look through the claim and the patient record to be able to tell if the patient has gotten a fractured femur or a fractured humerus.
Therefore, The action that the provider's office need to take is that the provider's office need to review the codes and ensure sure they are the correct ones. The provider then need to inform the coder to do a lot of investigation on the code as well as also add a lot of details to all of the code.
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Q: Health care providers are responsible for documenting and authenticating legible, complete, and timely patient records in accordance with federal regulations and accrediting agency standards. The provider is also responsible for correcting or altering errors in patient record documentation. A patient record documents health care services provided to a patient and includes patient demographic data, documentation to support diagnoses and justify treatment provided, and the results of treatment provided.
The coder assigned a CPT code to "x-ray, right femur" and an ICD-10-CM code to "fracture, right humerus." The health insurance company denied reimbursement for the submitted claim due to lack of medical necessity. What action should the provider's office take?
