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Thread: Limiting the E/M codes on a superbill

  1. #1
    Join Date
    Apr 2007
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    25

    Default Limiting the E/M codes on a superbill

    I'm wondering if anyone has a reference regarding the limiting of E/M codes on a superbill/encounter form?

    Once upon a time, I was told that if the E/M CPT codes are limited on the superbill, it can be interpreted to be 'directing' the provider to only choose those codes. Example: For Inpatient care, only the 99222 and 99223 are listed on the superbill. Leaving off the 99221 can look like the provider is being 'pushed' to choose a higher level.

    I know this is not good business practice to limit them on the superbill, and of course, providers need a reference, so I would really appreciate any help on this.
    Thanks, everyone!
    Cindy L. Swan, CPC CEMC

  2. #2
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    Apr 2007
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    Norwich
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    23

    Default

    I was told the same thing by an auditor a few years back. We use 99211, 2, 3, etc and it works.

  3. #3
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    Apr 2007
    Location
    Austin, Texas
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    Default

    The provider should have each level for new and established codes for their decision making process without any subjective bias.

  4. #4
    Join Date
    Apr 2007
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    25

    Default Limiting the E/M codes on a superbill

    Right! Thank you for the confirmation. It would be really great if there was a reference out there....so if anyone has one, please let me know. I will keep looking.
    Thanks!
    Cindy L. Swan CPC, CEMC

  5. #5
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,068

    Default

    Several years back there was an OIG case regarding auditing for the E&M levels. In the write up
    They stated that upon review of the superbills several of the providers were fined due to only representing the highest levels. You may still be able to locate this on the OIG website or try a google search.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Join Date
    Apr 2007
    Posts
    25

    Default

    Wow...thanks for the information. I will go search the OIG right now!
    Cindy

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