1formissy
Guru
Hi all,
I actually work for an insurance company, and I have a claim I am reviewing. The documentation shows an E/M, and patient was given Gilenya for her first treatment.
The patient was checked every hour, for 6 hours.
The provider is reporting the E/M code, 99213, and two prolonged codes, 99354, and 99355 x 10 units.
I am having a hard time reasoning that the codes reported are appropriate for simple hourly checks on this patient. It even states in the record, "Patient went and had lunch with husband and returned to the office."
Would like to know what your opinion is on this?
Thank you in advance!
I actually work for an insurance company, and I have a claim I am reviewing. The documentation shows an E/M, and patient was given Gilenya for her first treatment.
The patient was checked every hour, for 6 hours.
The provider is reporting the E/M code, 99213, and two prolonged codes, 99354, and 99355 x 10 units.
I am having a hard time reasoning that the codes reported are appropriate for simple hourly checks on this patient. It even states in the record, "Patient went and had lunch with husband and returned to the office."
Would like to know what your opinion is on this?
Thank you in advance!