dlinger63
Guest
Is it normal or legal or ethical for a coder to downcode a physician's or APP's outpatient visit without consulting the provider?
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Wiki Downcoding
- Thread starter dlinger63
- Start date
dingersol
New
This thread may help:. https://www.aapc.com/discuss/threads/changing-level-of-e-m.128974/
it has quite a bit of explanation.
it has quite a bit of explanation.
OpenClaims
Guest
This depends on the reasoning. If the provider bills a 99215, but the visit is clearly a 99214, then you would drop the level, because the visit doesn't meet criteria for 99215. However, if they document 50 minutes with the patient and the visit MDM supports a 99214, then you are okay to use the time as the deciding factor for a 99215 justification.