staceylw31@aol.com
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I am just looking for some guidance on this one. I work for a pediatric office, and we have a couple of Nurse Practitioners that insist on billing their visits at level 4. I have had to talk to them about it because we keep getting record audits from a couple of insurance companies. I have explained to them that the companies are saying these visits are level 3 because they are simple acute visits with low risk. One of my NP's thinks that if she adds 10,000 DX codes it will get her to a higher level even though when I go through the visit most are redundant codes. My one NP is trying to tell me that coding for pediatric patients is usually a higher level. We have an MDM calculator that they are supposed to use (Created by a PEDIATRIC EHR Company that WE use) and most of the 4s I am getting at 3s. Our office also does a 2 hour walk in service daily which is for acute sick visits where patients can just check in and be seen. I have also told them that these visits are more than likely going to be 99213, but here we are again with mostly 99214's. For example, they try to bill a 99214 for an acute ear infection with nasal congestion even though it's a low risk visit or a 99214 for an acute throat pain visit that is dx's with acute pharyngitis and an in office strep test that was negative. I also tried to explain that you do not get separate points for ordering the test and reviewing a test. I am seriously considering going for my auditing certification because they are driving me crazy. Any advice on how I can make them better understand how serious this is?