1. S

    Wiki 99214

    Can anyone give me examples of 99214 justifications during a skin exam.
  2. S

    Wiki 99214 for NEO's

    Does noting a neoplasm and scheduling surgery justify a 99214?
  3. L

    Wiki Addiction Recovery Billing

    Hello! I work at an addiction recovery office who give Vivitrol injections to our patients. My bosses feel that we should be billing 99204 and 99214 more. I'm concerned that this is going to cause a lot of denials for our billing team. I rarely bill a level 4 because our patients come back every...
  4. M

    Wiki Molina is automatically downcoding office visits without requesting medical records.

    I do billing for an internal medicine physician who specializes in weight management. Most of his visits are coded as 99214 or 99215 + 99401 or 99402. We do not have a lot of Molina patients, but of the ones we do have, every single claim gets downcoded from 99214 to 99213. We do not receive a...
  5. N

    Wiki Bundled Office Visit w/ -25

    We have been getting denials recently from Humana when billing 99214-25 (I70.233, F17.218, I89.0) 11042 (L97.312, L97.212, T81.31XA) Dx are different for each code. Only thing I can think of is the i70.233 and L97 codes both address the 'right leg' .. BUT we have been getting paid before with...
  6. V

    Wiki Need answers for billing 99204 & 99214

    I have been running around in circles trying to get a few questions answered by an E/M coding expert...I have contacted my local chapter many times, old professors, etc and have gotten nowhere... kinda frustrating...I have Read all the guidelines/watched all PP presentations but nothing answers...
  7. N

    Wiki 991213 or 99214?

    How would you code a visit for a HTN, ADHD or other chronic condition that requires management, where the pt is controlled and the physician is meeting all 4 HPI elements? Would you bill as 99213 or 99214? Thanks in advance!
  8. A

    Wiki Coding Based on Time

    I have a provider questioning the coding of time. For example a 99213 is 15 minutes and 99214 is 25 minutes. (I realize it has to be greater than these "typical" times with greater than 50% in counseling and coordination). The provider is saying if it is 21 minutes you would round up to the...
  9. F

    Encounter for preoperative examination.

    Encounter for preoperative examination Is it appropriate to code Z01.811 Encounter for pre-procedural respiratory examination and 99214. The office visit was for a pre-surgery exam on a child that is having dental surgery under sedation.
  10. C

    Wiki Billing an annaul & E/M at the same time.

    It is my understanding that the annual exam needs a complete past, family & social history. pt. also has a level 4 (99214) illness, how do you separate the history for the annual and the E/M code?
  11. N

    Wiki 99213 vs 99214 dispute

    Im having a dispute concerning 99213 vs 99214 with a docter i work for. I code on an EHR system and he will not sign off on my codes because he does not believe im correct. I refuse to down code for fear of being audited and charged with fraud. The problem is that the patient comes in for an...
  12. N

    Wiki HELP! E/M confusion (99214)

    The majority of the patients we code are established patients. I was taught always to use the MDM in the EM selection. However this has brought on somewhat of a confusion. In all documentation I've researched, I've found the same thing... it only takes one element of risk to qualify for that...
  13. K

    Wiki Office visit and INR

    Hi, We billed 99214-25 and 85610QW and received a denial from medicare for the office visit. When we called them they said they need a different modifier. Am I missing something? Modifier 25 was attached to the charge...any ideas. Also, when we are billing the 99211-25 when appropriate and the...