Question E/M coding

pannell

New
Messages
3
Location
Durango, CO
Best answers
0
So I have a question as a certified coder can I choose an E/M code based on the documentation provided. What are the liabilities and what are other clinics doing.
Thank you
 

Orthocoderpgu

True Blue
Messages
1,932
Location
Salt Lake City, UT
Best answers
9
So I have a question as a certified coder can I choose an E/M code based on the documentation provided. What are the liabilities and what are other clinics doing.
Thank you
Is part of your question missing? The E/M is based on the documentation. If the E/M levels are not supported by the documentation that opens you up to fines and penalties. Look under false claims act.
 

pannell

New
Messages
3
Location
Durango, CO
Best answers
0
Is part of your question missing? The E/M is based on the documentation. If the E/M levels are not supported by the documentation that opens you up to fines and penalties. Look under false claims act.
Right. So right now my providers select the E/M and I check and make sure the documentation supports the level they have chosen, if not I query them with my findings. They want me just to change it.
 

Orthocoderpgu

True Blue
Messages
1,932
Location
Salt Lake City, UT
Best answers
9
Right. So right now my providers select the E/M and I check and make sure the documentation supports the level they have chosen, if not I query them with my findings. They want me just to change it.
I don't see an issue here. Providers don't choose E/M levels based on the official guidelines since they don't learn them. If the providers are comfortable with you changing the E/M levels based on your knowledge of the E/M guidelines, that's fine. I think it's great that you have access to providers for questions that you may have. My providers learned to respect my coding experience and I was able to code based on documentation too.
 

sls314

Expert
Local Chapter Officer
Messages
465
Location
Toledo, OH
Best answers
1
Right. So right now my providers select the E/M and I check and make sure the documentation supports the level they have chosen, if not I query them with my findings. They want me just to change it.

That's really the way it should happen, IMO.

It wastes everyone's time if you consult with the physician each time you change an E/M level. As long as you're choosing a level that's supported by the documentation, there's no reason that you shouldn't be able to just code the level. You're the trained coder educated on the guidelines, not them.

I've seen other coders mention here that they have to get approval for every single change, and I couldn't work like that! I like to keep track and educate my providers on any trends in coding changes I've had to make, but I definitely don't run it by them every time!
 

jbhuju

Guru
Messages
132
Location
sierra vista, AZ
Best answers
0
i do have a question regarding this. what if provider select 99211? those are not billable under provider right? provider has to select atleast 99212 if i am not wrong? please help.
 

lgardner

Networker
Messages
90
Location
Tucson, AZ
Best answers
0
i do have a question regarding this. what if provider select 99211? those are not billable under provider right? provider has to select atleast 99212 if i am not wrong? please help.
this is correct.
99211 is for ancillary/nurse services.

a provider seeing a patient, should be at least a 99211.
 
Top