Wiki Limiting EM codes on a superbill

[cswan]

I?m wondering if anyone has a reference regarding the limiting of E/M codes on a superbill/encounter form?

Once upon a time, I was told that if the E/M CPT codes are limited on the superbill, it can be interpreted to be ?directing? the provider to only choose those codes. Example: For Inpatient care, only the 99222 and 99223 are listed on the superbill. Leaving off the 99221 can look like the provider is being ?pushed? to choose a higher level.

In my heart, I know this is not good business practice to limit them on the superbill, and of course, providers need a reference, so I would really appreciate any help on this

Cindy L. Swan CPC, CEMC

 

[cjhalk@yahoo.com]

I?m wondering if anyone has a reference regarding the limiting of E/M codes on a superbill/encounter form?

Once upon a time, I was told that if the E/M CPT codes are limited on the superbill, it can be interpreted to be ?directing? the provider to only choose those codes. Example: For Inpatient care, only the 99222 and 99223 are listed on the superbill. Leaving off the 99221 can look like the provider is being ?pushed? to choose a higher level.

In my heart, I know this is not good business practice to limit them on the superbill, and of course, providers need a reference, so I would really appreciate any help on this

Cindy L. Swan CPC, CEMC

I think limiting E&M codes presents a big problem. Leaving off an option gives the provider the idea that that code is not an option and overbilling most likely will take place. If you leave off 99221 and the provider only did a straight forward MDM and the only option for the provider to see is 99222 and higher, obviously that will lead to overbilling and over coding. I would most definitely get the 99221 on there. Better yet in my opinion is to just have the coder code off the H&P.

I think the best reference would be to have them look at their own notes. Have an auditor come in and audit just the 99221-99223. That way they can see their own work and see that they are over coding and over billing for the missing 99221. I did a short search, and I couldn't find any reference point that gives guidance to leaving or taking off E&M codes. But there is solid info out there regarding overbilling - you just have to look.

You could reference the great responses on your last post of this subject -
https://www.aapc.com/memberarea/forums/showthread.php?t=106033

This is a good article
http://www.aafp.org/news/practice-professional-issues/20120918racaudits.html

This is a good one
http://radiology.mckessonrevenews.c...ending-increased-billing-of-higher-eam-levels