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Thread: Have to Share this

  1. #1
    Join Date
    Apr 2007

    Default Have to Share this

    AAPC: Back to School
    Hello Everyone -

    I HAD to share this with you -

    I have a client who I have sent me his denials for the past 5 months or so. I reviewed them and there are about 15, for the week of Thanksgiving 2009 that are critical care 99291, that were denied. That's not a problem you think?!? Well, the problem with the billing is: the charts are coded 99291, for critical up to 30 minutes. The critical cares that are 1 hour plus are coded 99291 and the prolonged code 99356 and 99357. WOW.

    I called the physician this morning to tell him about what I found, he says that's the correct way of coding a critical care over 30 minutes. I explained to him that was incorrect and he says "I told the previous biller that's how it should be coded".

    I have a meeting with him this afternoon to discuss this further and show him the CPT coding book. He did not sound too upset about the conversation -- that's not the issue. The issue is he thinks this is the correct and only way. He does not know why they got denied. WOW.

    I wonder what I got myself into and wonder.....ummmmmmmmmmm, is this why the other person decided to leave this company?

    I'll keep you guys posted.
    Karen, CPC
    Physician Chart Auditor

  2. #2
    Join Date
    Apr 2007
    Everett, WA


    Ah, the process of educating the provider let alone ourelves, plus the look in his eye when he realizes that he's lost a lot of revenue, plus the distinguishing moment when he asks about rebilling for all those denied claims of the past. Yikes! ---Suzanne

  3. #3
    Join Date
    Apr 2007
    Biloxi, MS


    Gotta love them doctors... What an interesting position to be in. I'm sure once he gets it you will be the "hero". Yikes on the clean-up though.

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