Wiki Changing CPT for coverage

[cwestman]

I'm hoping someone can direct me to tangible information that will support changing the practice my employer uses
Currently all patients including straight medicare pt's are requested to have an annual physical . Medicare does cover 1 Welcome to Medicare exam IPPE(G0402) within the first year of enrollment but doesn't cover preventitive annual exam after that(such as G0438 or G439).Unfortunatley staff continues to schedule those medicare patients for an anuual exam every year. I know that we can offer an AW and allow the patient to make an informed decision ,and that they must sign an ABN as well as be made known of the cost of the service.However none of that is currently being done

I have been asked recently to change a CPT such as 99397 to a covered service CPT 99212-99215,depending. I'm very uncomfortable with this
I'm wondering if there is any information/documentation that I can give my employer to help them understand the error of this practice.If the CC indicates AW exam and the documentation suports same it just seems wrong to chnage the CPT.I have discussed the use of ABN's and informing the patients regarding coverage,however the practice continues.Perhaps I'm wrong but it really desn't seem appropriate .
Really appreciate any advice,at a loss for what to do

Cheri W CPC-A

 

[heatherposchman1]

Unless the provider amends the documentation to support any coding changes I also do not change those codes. Changing a code simply for reimbursement purposes is considered Insurance fraud.. We often have this issue in our office as well and if the secretary schedules the visit wrong and the provider is not willing to amend the note, those charges are adjusted off and not billed to the patient. Unless the documentation is amended the visit should not be re-coded for reimbursement. Just my two cents!

Heather P. CPC, CPCD

 

[cwestman]

So glad to hear,thank you!

 

[tracylc10]

I completely agree with Heather. The Ob/Gyns that I currently work for, do the same. I am so frustrated with them, that I am actively trying to find a new job.