Part B Insider (Multispecialty) Coding Alert
This MAC Plans to Audit Level 5 Codes
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If your physician’s go-to codes are 99205 and 99215, look for a lot more scrutiny of your claims going forward. At least that’s the word from one Part B MAC, which plans to start prospectively auditing these claims.
“The National Government Services Medical Review Department will be conducting service-specific prepayment reviews of CPT® codes 99205 and 99215 for claims submitted to Jurisdiction 6 Part B for the states of Illinois, Minnesota, and Wisconsin,” NGS Medicare said in an Oct. 1 announcement. “If one of your claims is selected for review, you will receive an Additional Documentation Request (ADR) letter,” the MAC continued. “You will have 30 days from the date of the ADR to submit the requested documentation.”
And for those of you confident that your history and physical always meet level five because you have a thorough electronic medical record (EMR), keep in mind that NGS will be looking beyond those two elements. “Please remember that the volume of documentation is not the determining factor for choosing the appropriate level of E&M service,” the MAC says. “The level of service provided and billed must be medically necessary in addition to meeting the individual requirements of the billed CPT® code.”
To read more on the audit, visit http://www.ngsmedicare.com.
Part B Insider (Multispecialty) Coding Alert
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This MAC Plans to Audit Level 5 Codes
If your physician’s go-to codes are 99205 and 99215, look for a lot more scrutiny [...]