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Medicare Down Coding

  1. Default Medicare Down Coding
    Medical Coding Books
    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

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    are you certain these are consults and not transfer of care?

  3. Default
    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

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Did the documentation meet the consultation requirements - Request/Render/Report?
    Lisa Bledsoe, CPC, CPMA

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