This scenario presents a professional challenge due to the inherent variability in audiological test results and the potential for misinterpretation, which can lead to inappropriate clinical recommendations and patient harm. The audiologist must navigate the complexities of data interpretation, considering not only the raw test results but also the patient’s history, symptoms, and the limitations of the diagnostic tools. Ethical and regulatory obligations mandate that decisions are evidence-based, patient-centered, and adhere to professional standards of care. The best approach involves a comprehensive review of all available data, including the patient’s presenting complaints, medical history, previous audiological records, and the results of the current audiological assessment. This holistic evaluation allows for a nuanced understanding of the patient’s auditory status. Specifically, it requires correlating the objective findings (e.g., audiogram, tympanometry, OAEs, ABR) with the subjective reports of hearing difficulties and functional impact. This integrated interpretation, considering the degree of hearing loss, its configuration, type, and the patient’s communication needs, forms the basis for evidence-based clinical decision-making. This aligns with the ethical principles of beneficence and non-maleficence, ensuring that interventions are appropriate and beneficial, and with regulatory requirements that mandate competent and ethical practice. An approach that relies solely on a single test result, such as an audiogram, without considering the broader clinical picture, is professionally unacceptable. This overlooks the possibility of test artifact, the impact of concurrent medical conditions, or the patient’s subjective experience, potentially leading to an inaccurate diagnosis and inappropriate management plan. This failure to conduct a thorough and integrated interpretation violates the standard of care and could result in patient detriment. Another professionally unacceptable approach is to make a diagnosis or treatment recommendation based on assumptions about the patient’s lifestyle or perceived motivation without objective corroboration. This introduces bias and can lead to stigmatization or the provision of suboptimal care. Ethical guidelines and professional practice standards emphasize objective assessment and patient-centered care, free from prejudice. Furthermore, an approach that delays or avoids communicating findings and recommendations to the patient or referring physician, or fails to document the decision-making process adequately, is also professionally unsound. Transparency, clear communication, and thorough record-keeping are fundamental to patient safety, continuity of care, and professional accountability, as mandated by regulatory bodies and ethical codes. The professional decision-making process for similar situations should follow a structured framework: 1. Gather all relevant information: Patient history, symptoms, previous records, and current test results. 2. Analyze and integrate data: Correlate objective findings with subjective reports, considering test limitations and potential confounding factors. 3. Formulate differential diagnoses: Consider all plausible explanations for the observed findings. 4. Develop a management plan: Based on the most likely diagnosis and the patient’s needs and preferences, outline appropriate interventions, referrals, or further investigations. 5. Communicate findings and plan: Clearly explain the results and proposed course of action to the patient and relevant healthcare providers. 6. Document the process: Maintain detailed records of all assessments, interpretations, decisions, and communications. 7. Monitor and re-evaluate: Follow up with the patient to assess the effectiveness of the intervention and make adjustments as needed.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed preference and the audiologist’s clinical judgment regarding the most appropriate course of action for their audiological rehabilitation. Navigating this requires careful consideration of patient autonomy, professional responsibility, and the potential for harm or suboptimal outcomes. The audiologist must balance respecting the patient’s wishes with ensuring they receive evidence-based care that maximizes their benefit and minimizes risk. Correct Approach Analysis: The best professional practice involves a thorough, patient-centered discussion that prioritizes shared decision-making. This approach begins by actively listening to and acknowledging the patient’s stated preference and the reasons behind it. The audiologist then clearly and empathetically explains their clinical recommendation, detailing the evidence supporting it, the potential benefits, and any risks or limitations associated with the patient’s preferred option. This explanation should be tailored to the patient’s understanding, using clear language and avoiding jargon. The goal is to empower the patient with comprehensive information, allowing them to make an informed choice that aligns with their values and goals, even if it differs from the audiologist’s initial recommendation. This aligns with ethical principles of patient autonomy and beneficence, as well as professional guidelines that emphasize informed consent and patient-centered care. Incorrect Approaches Analysis: One incorrect approach involves immediately dismissing the patient’s preference and insisting on the audiologist’s recommended course of action without further discussion. This fails to respect patient autonomy and can lead to a breakdown in the therapeutic relationship, potentially causing the patient to feel unheard or disrespected. It also bypasses the crucial step of understanding the patient’s motivations, which might reveal underlying concerns or misconceptions that could be addressed. Another incorrect approach is to simply agree to the patient’s preferred option without adequately explaining the potential drawbacks or offering the evidence-based alternative. This prioritizes patient satisfaction over professional responsibility and could result in a suboptimal outcome for the patient, potentially leading to dissatisfaction later when the limitations of their chosen path become apparent. This approach neglects the audiologist’s duty to provide the best possible care and to ensure the patient is fully informed of all viable options and their consequences. A third incorrect approach involves presenting the audiologist’s recommendation as the only acceptable option and framing the patient’s preference as inherently flawed or unreasonable. This can be perceived as paternalistic and dismissive, undermining the patient’s confidence in the audiologist and their ability to make decisions about their own health. It creates an adversarial dynamic rather than a collaborative one, hindering effective communication and shared decision-making. Professional Reasoning: Professionals should employ a decision-making framework that begins with active listening and empathy to understand the patient’s perspective. This is followed by a clear, evidence-based explanation of all viable options, including their benefits, risks, and limitations, presented in a manner understandable to the patient. The process culminates in a collaborative discussion to reach a shared decision that respects patient autonomy while upholding professional standards of care and ensuring the patient’s well-being. This iterative process of information exchange and collaborative dialogue is fundamental to ethical and effective audiological practice.

The scenario presents a common challenge in audiology practice: navigating the implications of a professional certification’s blueprint weighting and scoring on a candidate’s career progression and the institution’s responsibility. The core difficulty lies in balancing the need for objective assessment with the potential impact of policy on individual audiologists and the integrity of the profession. Careful judgment is required to ensure that policies are applied fairly, transparently, and in a manner that upholds professional standards. The best professional approach involves a thorough understanding and transparent communication of the certification body’s blueprint weighting, scoring, and retake policies. This includes proactively educating candidates about the examination structure, the rationale behind the weighting of different content areas, and the specific criteria for passing and retaking the exam. Such an approach ensures that candidates are fully informed and can prepare effectively, minimizing surprises and fostering a sense of fairness. This aligns with ethical principles of transparency and informed consent, as well as professional guidelines that emphasize clear communication of assessment procedures. An incorrect approach would be to assume that candidates will intuitively understand the examination’s structure and policies without explicit guidance. This lack of proactive communication can lead to misunderstandings, feelings of unfairness, and potentially hinder a candidate’s ability to prepare adequately. It fails to uphold the professional responsibility to support and inform candidates throughout the certification process. Another incorrect approach is to implement arbitrary or inconsistent retake policies that are not clearly defined or communicated. This could involve making decisions about retakes based on subjective factors or without a clear rationale tied to the examination blueprint. Such practices undermine the credibility of the assessment process and can create an environment of uncertainty and distrust. It violates principles of fairness and due process. Finally, an approach that prioritizes the institution’s administrative convenience over the candidate’s understanding and preparation is also professionally unacceptable. This might involve making retake decisions solely based on scheduling or resource availability without considering the candidate’s performance relative to the blueprint and scoring criteria. This demonstrates a lack of commitment to the candidate’s professional development and the integrity of the certification process. Professionals should employ a decision-making framework that prioritizes transparency, fairness, and candidate support. This involves: 1) Thoroughly understanding the examination blueprint, scoring methodology, and retake policies of the relevant certifying body. 2) Proactively communicating this information to candidates in a clear and accessible manner. 3) Establishing and consistently applying retake policies that are directly linked to the examination’s structure and scoring. 4) Providing resources and support for candidates who do not initially pass, guiding them on how to address areas of weakness identified through the assessment.

This scenario presents a professional challenge because it requires the audiologist to balance the patient’s expressed preferences with evidence-based best practices and the ethical imperative to provide the most effective and appropriate care. The patient’s desire for a specific, potentially less effective, intervention creates a conflict that necessitates careful navigation to ensure patient autonomy is respected while also upholding professional standards and regulatory requirements. The best approach involves a comprehensive diagnostic assessment followed by a detailed discussion of all viable therapeutic options, including their respective benefits, limitations, and evidence base. This approach prioritizes patient-centered care by ensuring the patient is fully informed and empowered to make a decision aligned with their values and goals, while also adhering to the principles of professional competence and due care mandated by audiology practice acts and ethical codes. Specifically, this aligns with the requirement to provide services within the scope of practice and to ensure that interventions are based on sound scientific evidence and clinical judgment. The audiologist must document this informed consent process thoroughly. An approach that immediately concedes to the patient’s initial request without a thorough assessment or discussion of alternatives fails to uphold the audiologist’s professional responsibility to provide optimal care. This could lead to suboptimal outcomes and potentially violate regulatory requirements concerning the standard of care and the need for evidence-based practice. Another unacceptable approach is to dismiss the patient’s preference outright and unilaterally decide on a treatment plan. This disregards patient autonomy and the ethical principle of shared decision-making, potentially eroding trust and leading to non-compliance. It also fails to acknowledge the patient’s right to be involved in their own healthcare decisions, a cornerstone of ethical practice. Finally, an approach that focuses solely on the cost-effectiveness of interventions without adequately considering the patient’s individual needs, preferences, and the efficacy of different treatments is also professionally unsound. While cost is a factor, it should not be the primary determinant of therapeutic choice when other interventions may offer superior clinical outcomes or better align with the patient’s quality of life goals. This could also lead to regulatory scrutiny if it results in the provision of substandard care. Professionals should employ a decision-making framework that begins with a thorough assessment, followed by open communication with the patient about all evidence-based options. This framework emphasizes shared decision-making, informed consent, and the ethical obligation to provide the most appropriate and effective care based on the individual patient’s needs and circumstances, always within the bounds of professional scope and regulatory guidelines.

The review process indicates a common challenge faced by audiologists preparing for advanced clinical practice competency assessments: effectively utilizing available resources and managing their preparation timeline. This scenario is professionally challenging because the stakes are high, impacting career progression and the ability to provide advanced patient care. A structured, evidence-based approach to preparation is crucial, rather than relying on ad-hoc methods or solely on personal experience. Careful judgment is required to balance comprehensive review with efficient time management, ensuring all competency domains are adequately addressed without burnout. The best approach involves a systematic review of the official assessment blueprint, identifying key knowledge areas and practical skills. This should be followed by a personalized study plan that prioritizes weaker areas, incorporates diverse learning methods (e.g., reading, practice questions, case studies, peer discussion), and allocates specific time blocks for each topic. Integrating mock assessments under timed conditions is vital to simulate the actual exam experience and gauge readiness. This method is correct because it directly aligns with the principles of competency-based assessment, ensuring that preparation is targeted, comprehensive, and practical. It respects the candidate’s existing knowledge while systematically addressing gaps, mirroring the professional development expected in advanced practice. This approach is also ethically sound, as it demonstrates a commitment to professional standards and patient safety by ensuring adequate preparation for the assessment. An approach that focuses exclusively on reviewing past personal clinical notes without consulting the official assessment guidelines is professionally unacceptable. This fails to acknowledge the specific requirements and scope of the competency assessment, potentially leading to a misallocation of study time and overlooking critical areas. It also lacks regulatory justification, as professional assessments are designed to evaluate against established standards, not individual past practices. Another professionally unacceptable approach is to rely solely on informal study groups without a structured plan or access to official assessment materials. While collaboration can be beneficial, an unstructured approach can lead to the reinforcement of misconceptions or an incomplete understanding of the required competencies. This deviates from the professional obligation to prepare thoroughly and systematically for an assessment that impacts patient care. Finally, delaying intensive preparation until the final weeks before the assessment is a flawed strategy. This approach creates undue stress, hinders deep learning and retention, and increases the likelihood of superficial understanding. It fails to meet the professional standard of diligent preparation and can compromise performance on an assessment designed to evaluate advanced clinical competence. Professionals should employ a decision-making framework that begins with understanding the assessment’s objectives and scope (e.g., by thoroughly reviewing the official blueprint). This should be followed by a self-assessment of current knowledge and skills, identifying areas requiring development. Based on this, a realistic and structured preparation plan should be created, incorporating a variety of learning resources and practice opportunities. Regular self-evaluation and adaptation of the plan are key to ensuring effective and efficient preparation.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed preference and the audiologist’s clinical judgment regarding the most appropriate course of action for their auditory rehabilitation. Navigating this requires a delicate balance of patient autonomy, professional expertise, and adherence to ethical and regulatory standards governing allied health practice in North America. The audiologist must ensure the patient’s well-being and safety while respecting their right to make informed decisions, even if those decisions deviate from the audiologist’s recommendation. Correct Approach Analysis: The best professional practice involves a comprehensive discussion with the patient, clearly outlining the audiologist’s rationale for recommending a specific hearing aid technology, detailing the potential benefits and limitations of that technology in relation to the patient’s specific hearing loss and lifestyle, and thoroughly explaining the risks and benefits associated with the patient’s preferred, less advanced technology. This approach respects patient autonomy by providing them with all necessary information to make an informed choice, while also fulfilling the audiologist’s ethical duty of care to ensure the patient understands the implications of their decision. This aligns with principles of informed consent, a cornerstone of allied health practice, which mandates that patients receive sufficient information to make voluntary decisions about their care. Regulatory frameworks in North America emphasize patient-centered care and shared decision-making, requiring practitioners to engage in open communication and ensure comprehension. Incorrect Approaches Analysis: Recommending the less advanced technology without a thorough discussion of its limitations and potential risks, despite clinical judgment suggesting otherwise, fails to uphold the audiologist’s duty to provide the most appropriate care and could lead to suboptimal outcomes or patient dissatisfaction. This approach prioritizes expediency over patient understanding and potentially compromises the patient’s auditory health. Proceeding with the patient’s preferred, less advanced technology without fully exploring the audiologist’s concerns or ensuring the patient comprehends the potential drawbacks represents a failure in the duty of care and informed consent, as the patient may not be making a truly informed decision. This could be construed as a breach of professional standards that require practitioners to advocate for the best interests of their patients based on their expertise. Insisting on the audiologist’s recommended technology and refusing to consider the patient’s preference, even after discussion, disregards patient autonomy and can lead to a breakdown in the therapeutic relationship, potentially violating ethical guidelines that promote patient self-determination. Professional Reasoning: Professionals should employ a shared decision-making framework. This involves: 1. Assessing the patient’s needs and preferences. 2. Presenting evidence-based treatment options, including their risks, benefits, and alternatives. 3. Eliciting the patient’s values and preferences. 4. Collaboratively deciding on a course of action that aligns with both clinical evidence and patient goals. In situations of disagreement, a structured dialogue that prioritizes clear communication, empathy, and mutual respect is crucial.

This scenario presents a professional challenge because it requires the audiologist to integrate complex anatomical and physiological knowledge with the practical application of biomechanical principles to diagnose and manage a patient’s hearing loss. The challenge lies in accurately interpreting the findings from various audiological tests, understanding how the physical structures of the auditory system are functioning (or not functioning), and then applying this understanding to develop an appropriate intervention plan. The patient’s history of fluctuating symptoms and the need for objective verification of subjective complaints add layers of complexity, demanding careful judgment to avoid misdiagnosis or inappropriate treatment. The best professional approach involves a systematic and evidence-based methodology that prioritizes objective data and correlates it with the patient’s subjective experience. This approach begins with a comprehensive case history, followed by a thorough audiological evaluation including pure-tone audiometry, tympanometry, and acoustic reflexes. Crucially, it then involves interpreting these results in the context of the known anatomy and physiology of the auditory pathway, from the outer ear through the central auditory nervous system. Applied biomechanics is considered when evaluating the mechanical properties of the middle ear (e.g., compliance, pressure) and the cochlea’s response to sound. This integrated analysis allows for the differentiation of conductive, sensorineural, or mixed hearing loss, and the identification of potential underlying pathologies based on the biomechanical implications of the test results. This aligns with professional standards of practice that mandate accurate diagnosis and evidence-based treatment planning, ensuring patient safety and optimal outcomes. An incorrect approach would be to rely solely on the patient’s subjective reports without adequate objective verification. This fails to acknowledge the limitations of subjective reporting and the necessity of audiological testing to confirm or refute perceived hearing difficulties. Such an approach risks misinterpreting the nature and severity of the hearing loss, potentially leading to ineffective or even harmful interventions. Ethically, it violates the principle of beneficence by not ensuring the diagnosis is based on sound scientific evidence. Another incorrect approach would be to perform a battery of tests without a clear diagnostic hypothesis or a systematic interpretation framework. This “shotgun” approach, while gathering data, lacks the critical thinking and integration of anatomical, physiological, and biomechanical principles required for accurate diagnosis. It can lead to an overwhelming amount of data that is not effectively synthesized, resulting in a superficial understanding of the patient’s condition and potentially overlooking key diagnostic indicators. This demonstrates a failure to apply core competencies in audiological assessment. A further incorrect approach would be to prematurely recommend a specific intervention, such as hearing aids, based on initial subjective complaints without completing a full diagnostic workup. This bypasses the essential steps of differential diagnosis and understanding the underlying biomechanical issues contributing to the hearing loss. It is ethically problematic as it prioritizes a potential solution over a thorough understanding of the problem, potentially leading to an inappropriate or ineffective treatment that does not address the root cause of the patient’s hearing impairment. The professional reasoning process for similar situations should involve a cyclical approach: 1. Gather comprehensive subjective information (case history). 2. Formulate initial diagnostic hypotheses based on subjective data and known anatomical/physiological principles. 3. Select and administer objective audiological tests that are most likely to confirm or refute these hypotheses, considering the biomechanical implications of each test. 4. Interpret test results by integrating anatomical, physiological, and biomechanical knowledge to arrive at a definitive diagnosis. 5. Develop an evidence-based intervention plan tailored to the specific diagnosis and the patient’s needs. 6. Continuously re-evaluate the diagnostic hypotheses and intervention plan as new information becomes available or as the patient’s condition evolves.

Scenario Analysis: This scenario presents a professional challenge due to the inherent variability in audiological test results and the potential for misinterpretation, which can lead to inappropriate treatment plans and patient dissatisfaction. The audiologist must navigate the complexities of instrumentation accuracy, patient factors, and the need for objective, reproducible data to ensure optimal patient care. The ethical imperative is to provide accurate diagnoses and effective management strategies based on sound clinical judgment and adherence to professional standards. Correct Approach Analysis: The best professional practice involves a systematic approach to instrumentation troubleshooting and validation. This includes performing daily listening checks and electroacoustic calibration of all audiological equipment according to manufacturer specifications and established professional guidelines. This ensures that the equipment is functioning within acceptable parameters, thereby increasing the reliability and validity of the diagnostic data obtained. Regulatory bodies and professional organizations, such as the American Academy of Audiology (AAA) and the American Speech-Language-Hearing Association (ASHA), mandate the use of calibrated and functioning equipment for accurate audiological assessment. This approach directly addresses the potential for instrumentation error, a critical factor in diagnostic accuracy. Incorrect Approaches Analysis: Relying solely on patient self-report without verifying instrumentation performance is professionally unacceptable. While patient history is crucial, it cannot substitute for objective, calibrated measurements. This approach fails to adhere to professional standards for diagnostic accuracy and could lead to misdiagnosis or inappropriate treatment based on potentially flawed equipment readings. Assuming that equipment is functioning correctly simply because it was calibrated recently, without performing routine daily checks, is also professionally unsound. Calibration schedules are important, but daily listening checks and basic electroacoustic verification are essential to catch subtle drifts or immediate malfunctions that can occur between scheduled calibrations. This oversight risks generating inaccurate data without immediate detection. Using a different audiologist’s previous test results as a sole basis for current diagnosis, without independently verifying the instrumentation and re-testing, is ethically and professionally problematic. While historical data is valuable for tracking changes, it does not account for potential changes in the patient’s hearing status or the accuracy of the equipment used for the previous assessment. This approach bypasses the audiologist’s responsibility to conduct a current, accurate assessment. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety and diagnostic accuracy. This involves a multi-step process: 1. Understand the patient’s presenting complaint and history. 2. Select appropriate diagnostic tools and instrumentation. 3. Verify the functionality and calibration of all instrumentation through daily listening checks and electroacoustic calibration. 4. Conduct the audiological assessment, carefully observing patient responses and equipment readings. 5. Interpret the results in conjunction with patient history and other clinical findings. 6. If results are unexpected or inconsistent, re-evaluate instrumentation and re-test as necessary. 7. Formulate a diagnosis and management plan based on validated data and professional judgment. 8. Document all procedures, findings, and rationale thoroughly.

Scenario Analysis: This scenario presents a professional challenge due to the inherent risk of cross-contamination in an audiology clinic, particularly when handling shared equipment like otoscopes and tympanometers. Maintaining a sterile environment is paramount to patient safety and preventing the spread of infections, which directly impacts the quality of care provided. The audiologist must balance efficient patient flow with rigorous adherence to infection control protocols, requiring careful judgment and a commitment to best practices. Correct Approach Analysis: The best professional practice involves a systematic approach to disinfection and sterilization of all audiological equipment that comes into contact with patients. This includes the immediate and thorough cleaning of probe tips, specula, and any other reusable components after each patient use, followed by appropriate high-level disinfection or sterilization according to manufacturer guidelines and established infection control standards. This approach directly aligns with the principles of patient safety and infection prevention mandated by regulatory bodies and professional ethical codes, ensuring that the risk of pathogen transmission is minimized. Incorrect Approaches Analysis: One incorrect approach involves relying solely on visual inspection for cleanliness without implementing a standardized disinfection protocol. This fails to address microscopic pathogens that may remain on surfaces even after apparent cleaning, posing a significant risk of cross-contamination and violating infection control standards. Another incorrect approach is to only disinfect equipment at the end of the day. This practice creates a substantial window of opportunity for pathogen transmission between patients throughout the day, directly compromising patient safety and failing to meet the immediate disinfection requirements for reusable medical devices. A third incorrect approach is to assume that disposable probe covers are sufficient to prevent all cross-contamination without also disinfecting the underlying equipment. While disposable covers reduce direct contact, the equipment itself can still harbor pathogens, and relying solely on covers without proper equipment disinfection is an incomplete and unsafe practice. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety and regulatory compliance. This involves: 1) Identifying potential hazards (e.g., infection transmission). 2) Understanding relevant regulations and guidelines (e.g., CDC guidelines for infection control in healthcare settings, manufacturer instructions for equipment). 3) Evaluating available protocols and resources. 4) Selecting and implementing the most effective and compliant approach (e.g., a multi-step cleaning, disinfection, and sterilization process). 5) Regularly reviewing and updating protocols to ensure ongoing effectiveness and adherence to evolving standards.

The assessment process reveals a common challenge in audiology practice: balancing efficient patient care with meticulous adherence to regulatory requirements for documentation and coding. This scenario is professionally challenging because inaccurate or incomplete documentation can lead to significant financial penalties, audit failures, and even legal repercussions, impacting both the practice’s reputation and its ability to serve patients. Careful judgment is required to ensure that every clinical interaction is accurately reflected in the patient’s record in a way that meets all applicable standards. The best approach involves thoroughly documenting the patient’s diagnostic findings, the rationale for the recommended treatment plan, and the specific services provided during the appointment, using current and accurate CPT and ICD-10-CM codes that precisely reflect the clinical encounter. This ensures compliance with Medicare and other payer guidelines, which mandate that documentation must fully support the codes billed. Accurate coding and comprehensive documentation are essential for demonstrating medical necessity, facilitating proper reimbursement, and passing audits. This aligns with the ethical obligation to maintain accurate patient records and uphold professional standards. An incorrect approach would be to use generic or outdated diagnostic codes that do not fully capture the patient’s condition, even if the services rendered were appropriate. This fails to meet the specificity requirements of ICD-10-CM coding and can lead to claim denials or accusations of upcoding if the documentation does not support a more complex diagnosis. Another incorrect approach is to document only the services performed without clearly linking them to the diagnostic findings and the medical necessity for those services. This leaves the documentation vulnerable to audit scrutiny, as it may not adequately justify the billed services according to payer policies. Finally, relying solely on memory or informal notes for billing purposes without transferring this information into the official patient record is a significant regulatory failure. This practice violates the principle of maintaining a complete and accurate medical record, making it impossible to justify billed services if audited and potentially leading to accusations of fraud. Professionals should employ a decision-making framework that prioritizes accuracy and compliance. This involves staying current with coding updates (CPT and ICD-10-CM), understanding payer-specific documentation requirements, and implementing a robust internal review process for all patient records and billing information. Regular training and access to reliable coding resources are crucial. When in doubt about a code or documentation requirement, consulting with a coding specialist or relevant regulatory guidance is the most prudent course of action.