Wound care has an LCD problem that general scribes do not see. The first application and the fifth application are not the same visit. Coverage for a repeat graft is not inherited from the fact that the last one paid. It has to be re-established in this note, against this policy.

That means the measurements belong in the chart, not in a later addendum. It means the conservative-therapy trial is dated and described, not asserted. It means the product selected is the product whose HCPCS was billed — not the one that happened to be on the shelf.

Practices that treat LCD language as “payer work” leave it to billing. By then the encounter is closed and the facts are whatever the template captured. The reviewer will not call to ask what you meant.

Specialty-trained documentation puts the policy in the room while the note is still being written. That is slower on day one. It is the only pace that holds up when the letter arrives.