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Wiki 99214 downcoding

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Ree923

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Bolingbrook, IL
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Hello, I'm at an ophthalmology practice and lately we have been getting many more denials for CPT 99214 that are being downcoded to 99213. I'm having difficulty determining when to use the 99214 code. Is it really two organ systems? We only code for eye issues, so that means we can't use this code? Please advise
 
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Ree923 said:
Hello, I'm at an ophthalmology practice and lately we have been getting many more denials for CPT 99214 that are being downcoded to 99213. I'm having difficulty determining when to use the 99214 code. Is it really two organ systems? We only code for eye issues, so that means we can't use this code? Please advise
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Organ systems aren't a factor for level-based E/M codes and there are no diagnosis types I know of that automatically exclude higher level E/M visits.

I have heard of payers automatically downcoding higher level visits. Have you tried appealing any of these claims?
 
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