dreampeddler
Guest
Good Morning!
I need your help, fellow coders! One of our providers (I work for a health insurance company) submitted a code for an E&M visit and I reviewed it using the guidelines outlined in the E&M Handbook available on the CMS website. This apparently uses the 1997 Documentation Guidelines?
The provider indicates they use the 1995 Guidelines and as a payer, we don't have the choice of which set we require from our contracted providers. The provider indicated they have the right to choose (which I can see that they do) but that the payer doesn't have that same right.
This claim is for a non-Medicare patient. As a payer, can I review coding using the 1997 Documentation Guidelines and indicate a lower level of service is required, based on these?
Thanks so much!
Jodie, CPC
I need your help, fellow coders! One of our providers (I work for a health insurance company) submitted a code for an E&M visit and I reviewed it using the guidelines outlined in the E&M Handbook available on the CMS website. This apparently uses the 1997 Documentation Guidelines?
The provider indicates they use the 1995 Guidelines and as a payer, we don't have the choice of which set we require from our contracted providers. The provider indicated they have the right to choose (which I can see that they do) but that the payer doesn't have that same right.
This claim is for a non-Medicare patient. As a payer, can I review coding using the 1997 Documentation Guidelines and indicate a lower level of service is required, based on these?
Thanks so much!
Jodie, CPC