Fix
A documented procedure is no longer withheld when the note does not name the performer
Work processed after carries this change.
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| Status | Kind | What changed | Version | Ticket | Date |
|---|---|---|---|---|---|
| Released | Fix | A documented procedure is no longer withheld when the note does not name the performer | No version | No ticket |
Work processed after carries this change.
A missing provider name inside a procedure note no longer makes the procedure non billable. The autocoder was marking clearly documented procedures as non billable, with the reason "provider not documented", whenever the procedure section did not name the performer in line. That reason was never a valid rule. The autocoder resolves provider attribution later, so a missing name in one section is not a reason to withhold the code.
Flat fee procedures and neuraxial procedures are the ones you will notice. One case seen in production is a pre-operative combined spinal epidural catheter, code 62326. The procedure was documented, and the autocoder still marked it non billable. It bills now.
What to look out for: expect these procedures to appear as billable lines on notes where the performer is not named in the procedure section. Compare a few recent claims of this type against the record. When a procedure must not bill for a different reason, the autocoder still reports that reason.