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? downcoding from 99291

  1. Default ? downcoding from 99291
    Medical Coding Books
    i have a question, if the physician list 99291 but forgets to document his time, doesnt it default to 99285 if no answer is ever received from physician.

  2. Default Downcoding
    Yes, you are right. If it is not documented it cannot be coded. Therefore, if the physician did not document his time, you cannot code for it.

  3. Default Downcoding Continued
    Per the guidelines in the CPT manual, "Time spent with the individual patient should be recorded in the patient's record." Therefore if the time is not recorded it cannot be coded for. I hope that this helps.

  4. #4
    Location
    Milwaukee WI
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    Default NO
    No, it does not automatically "downcode" to 99285. You code the level and type of service that was documented.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Default
    Hi,

    We need to pend the chart and query the provider for Time request, if not received, then we cannot downcode to appropriate ER E/M code, but cannot be directly downcoded to 99285.

    Hope this helps you,

    Good day,

    Purnima S

    Quote Originally Posted by cgulledg View Post
    i have a question, if the physician list 99291 but forgets to document his time, doesnt it default to 99285 if no answer is ever received from physician.

  6. #6
    Default
    Quote Originally Posted by FTessaBartels View Post
    No, it does not automatically "downcode" to 99285. You code the level and type of service that was documented.

    F Tessa Bartels, CPC, CEMC
    Yes, Bartels is correct. You code the note for what it is worth. You do not just assume since the provider was trying to meet critical care and did not state the time, that it would be a 99285. You would code the note to see what you your 3 of 3 elements are. HPI, PE, MDM then select your code. Comp, Comp, High, or Detailed, Detailed, Low, etc.

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