tamjohn68
New
We are a cardiology practice and are having stuggles with one of our Medicare Risk plans denying 99225 or 99226 visits. We have been instructed by our billing company that this plan has it's own "rules" and they will only accept one subsequent visit code per day regardless of provider or diagnosis. We have been instructed to change our denied codes to office visit codes 99213 or 99214. I believe this advice to be incorrect. If Medicare Risk plans follow CMS guidelines then it would be inappropriate to change these codes in my opinion. I am curious if any other specialist office is struggling with billing for their services/visits on hospital outpatient/OBS codes? And, am I incorrect in thinking we should continue to bill these codes and appeal these denials? Any thoughts or experiences/suggestions on this topic will be very appreciated!