Wiki Notice any changes with E/M's compared to last year?

[metzger130]

Just wondering if anyone is noticing a difference in how many 99213, 99214, etc that they are billing out this year compared to last year with the change in the rules. Also wondering what you are seeing for you %'s of each code. A provider I bill for is doing approx 59% 99213's, 36.5% 99214's and the rest are 212's and 214's. Not sure if that is a bit high for 214's but they do a lot of hormone replacement patients and of course OB's.

Thanks for the information all!

 

[nielynco]

Just wondering if anyone is noticing a difference in how many 99213, 99214, etc that they are billing out this year compared to last year with the change in the rules. Also wondering what you are seeing for you %'s of each code. A provider I bill for is doing approx 59% 99213's, 36.5% 99214's and the rest are 212's and 214's. Not sure if that is a bit high for 214's but they do a lot of hormone replacement patients and of course OB's.

Thanks for the information all!

As long as the documentation supports the levels billed, you need not worry about how many are billed. But if you notice that your providers have changed the pattern of what they were billing last year, it is a flag for you to do an internal audit of the records to ensure that the documentation is supporting what was billed. Any drastic changes in billing patterns will be noticed by the payers and and could result in their requesting an audit so being proactive is always a good thing.

 

[tassjohn32]

I bill for a gyn and all we bill for are 99214 and preventive codes and for some months now (mainly BCBS) have been down coding to 99213. Do any of you know why this is happening? Documents show we can bill for 99214 and the doctor wants to start adding additional ICD 10 codes to support their documents and they still pay for 99213. She wants to add ICD 10 codes to support imaging orders (CT, TV ultra sounds, MRI, ect.) review of prior notes, and prescription order(except for birth control). I have found R93.5(Abn findings on DX imaging), Z71.2, Z76.89, Z76.0(medication refill). Can anyone HELP me please!