Ob-Gyn Coding Alert

Reader Questions:

With 2021 E/M Changes, Is Your Billing Frequency Changing? Find Out

Question: Is anyone else noticing a difference in how many 99213, 99214, etc. your ob-gyns are billing out this year compared to last year with the change in the E/M rules? The ob-gyn provider I bill for is doing approximately 59% 99213s, 36.5% 99214s, and the rest are 99212ss and 99214s. Not sure if that is a bit high for 99214s, but they do a lot of hormone replacement patients (and of course obstetric patients). Should I be concerned?

AAPC Forum Subscriber

Answer: As long as your documentation supports the E/M levels billed (99211-99215, Office or other outpatient visit for… an established patient …), you need not worry about how many you are billing.

However, if you notice that your providers have changed the pattern of what they were billing from last year, you should consider this a flag for you to do an internal audit of the records to ensure their documentation is supporting what you billed. Any drastic changes in billing patterns will be noticed by the payers and could result in their requesting an audit, so being proactive is always a good thing.

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