Wiki Medicare Down Coding

[brendalewing]

We have had several request from Pinnacle, CMS, for copies of our Ortho Consults, which CMS then down codes from a consult to 99202, then we are paid the lower reimbursiment. We have good documentation. Is any one else having this problems with Medicare?
Thanks,
Brenda Lewing, LPN, CPC

 

[mbort]

are you certain these are consults and not transfer of care?

 

[brendalewing]

yep, one was ER consult request from primary care and others were seen in our office at the request for consult from primary care physician

 

[Lisa Bledsoe]

Did the documentation meet the consultation requirements - Request/Render/Report?