deona4s
New
auditing records prior to billing and dr billed 99213 and record audited 99214, dr does not want to change code to 99214. is this ok?
we are being asked to audit 5 charts per dr a week and seeing alot of 99213's that audit at 99214. So they are getting so many that are 'undercoded' and charting graphs are showing deviations to the national average and they want to make sure we can explain that deviation. Our physicians do not want to change to 99214 and state that they want 99213 based on medical necessity so our company has added to our compliance plan ' our policy requires 2 of the 3 Medical Decision Making be one of the 2 required components'. Do you agree this is how we should handle this or do you have any other advice?Perhaps the doctor has a valid reason for not wanting to change it or disagrees with the audit finding - have you discussed it with him or her? Most audits are not final determinations and allow for a rebuttal process. With E&M coding, even two auditors may not always come up with the same code. Also keep in mind that you are looking at about a $35-$40 difference in payment between these codes. If this is an isolated instance, it is not a big deal in the scheme of things. Keep things in perspective.
we are being asked to audit 5 charts per dr a week and seeing alot of 99213's that audit at 99214. So they are getting so many that are 'undercoded' and charting graphs are showing deviations to the national average and they want to make sure we can explain that deviation. Our physicians do not want to change to 99214 and state that they want 99213 based on medical necessity so our company has added to our compliance plan ' our policy requires 2 of the 3 Medical Decision Making be one of the 2 required components'. Do you agree this is how we should handle this or do you have any other advice?