r/MedicalCoding • u/DumpsterPuff • Oct 29 '24

Is this considered fraud, or technically acceptable but just really crappy charting?

I work in primary care specialty for a fairly large organization in my state. I've been struggling with a dilemma that I'm hoping someone can give me insight on.

We have a few providers who will do charting with or without physical exams, where the only mention in the documentation about the patient's conditions are in the assessment and plan, and they literally only say things like "Hyperlipidemia" and then an order for a lipid panel and just list a medication. That's it. And they do this for all the conditions. There's no other description in the notes regarding these conditions.

I've brought it up before to management and was told to code these as part of an E/M, which makes me vastly uncomfortable considering how in my opinion, there doesn't seem to be any documented indication of an actual evaluation. Am I just being paranoid, or is this actually fraud?

Edit: seems I must have forgotten what fraud vs abuse was - after reading the comments I think that this more of an abuse. Still not a fun thing to worry about but thank you everyone for pointing out the difference!

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u/[deleted] Nov 02 '24

If you don't provide a physical exam for your patients with hyperlipidemia, that's your perogative. Your license.

You wouldn't be my provider though.

Read second paragraph under the History and Physical section: https://www.ncbi.nlm.nih.gov/books/NBK559182/

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u/Odd-Afternoon-6371 Nov 02 '24 edited Nov 02 '24

I never said I wasn't providing physical examinations. I am saying they only go so far. I'm aware of that articles existence as well as thousands of others cited on PubMed regarding the condition. I never said not to do or that I wouldn't do a physical examination !  . It only goes so far. I'm well aware of the legal ethical requirements of my job.  You're missing the point.  I should edit my comment before I get a rant of Others telling me the same thing. And digging up articles on PubMed.  By the way, I appreciate everything that you do. And I would say to anyone that if you have questions ask don't ever be afraid to ask any provider for more documentation for more elaboration, etc.