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Neurology & Pain Management Coding Alert

E/M Coding:

Leery of 99204 or 99214? Think Twice Before Automatically Dropping to 99203 or 99213

Published on Tue Aug 09, 2011

Lost revenue might not be the only price you pay for down coding. When your neurologist or pain management specialist sees patients in the office, you know to look for more specific details in order to justify reporting higher-level codes such as CPT 99204 or 99214. Don't fall into the trap of "being on the safe side" by undercoding, however. Reporting lower-level codes 99203 or 99213 doesn't just lower your provider's reimbursement -- you could be setting yourself up for an audit. Could You Be Triggering an Audit? The top reason many practices undercode is because they don't want to "trigger an audit." However, coding all lowlevel E/M codes is sure to get a payer's attention, because the claims reviewers will be wondering why you never provide high level evaluations to your patients. When claims reviewers study "bell curves" to determine whether a practice is coding outside the norm, they're looking [...]
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