rheumatologist

Our company is considering hiring a rheumatologist. This doctor seems to feel that all of his new and established patients will be level 4 or 5, every time.

I know enough to know that all coding is based on medical necessity and I just can't fathom any provider always having enough medically necessary documentation for high level codes every time. The tricky part is getting administration to understand this.

Has anyone ever come across anything like this before?

Sandy

I agree with the doctor!

It is rare that a rheum patient referred from a primary care doctor has something simple. Lupus, RA, even fibromyalgia are complex and counseling alone will get them to level 4. So those are likely to be level 4 and 5. Self referred patients with aches and pains may be lower levels.
Don't forget the income potential from infusions for the Rheumatoid arthritis patients

rheumatology

You might try to separate out new consults from established patient visits in your discussions. Have you checked the CMS norms for the specialty?