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Fix: Only bill a separate E/M service when the documentation supports distinct medical decision-making beyond "patient here for injection." Dose adjustments, side effect management, and review of treatment progress all support a separate E/M service, but they must be documented

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This was defined as a 1-point to 2-point decline in the Revised ALS Functional Rating Scale (ALSFRS-R) total score over an initial three-month observational period