mforsyth
New
I do billing for an internal medicine physician who specializes in weight management.
Most of his visits are coded as 99214 or 99215 + 99401 or 99402.
We do not have a lot of Molina patients, but of the ones we do have, every single claim gets downcoded from 99214 to 99213.
We do not receive a notice in advance. We do not receive a request for medical records substantiating the charges. Molina just automatically assumes we chose the wrong CPT code.
Interestingly enough, it seems 9/10 times if we just use 99214 or 99215 without any weight counseling code, it does not get downcoded.
Is this happening for anyone else? How do we prevent this from happening? Is this illegal for them to do this?
We are just upset that they aren't requesting documentation before doing this, and our provider really does spend the time and energy providing these services to his patients.
Most of his visits are coded as 99214 or 99215 + 99401 or 99402.
We do not have a lot of Molina patients, but of the ones we do have, every single claim gets downcoded from 99214 to 99213.
We do not receive a notice in advance. We do not receive a request for medical records substantiating the charges. Molina just automatically assumes we chose the wrong CPT code.
Interestingly enough, it seems 9/10 times if we just use 99214 or 99215 without any weight counseling code, it does not get downcoded.
Is this happening for anyone else? How do we prevent this from happening? Is this illegal for them to do this?
We are just upset that they aren't requesting documentation before doing this, and our provider really does spend the time and energy providing these services to his patients.