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Est.visits all 99212?

  1. Default Est.visits all 99212?
    Medical Coding Books
    Hi All,
    We have a NP who codes for ALL his established visits as 99212 regradless if the patient has (1 or 2 or 3) stable chronic illnesses with (HPI =EPF) the PE is always just Problem Focused and MDM continue all medications and he will just say that it's up to me to UPCODE..is this RIGHT??

    Pls.advise and thanks..

  2. #2
    Location
    Swainsboro/Statesboro, GA
    Posts
    753
    Default Concerns
    Your question is hard to answer based on the info provided. However, I would definitely be concerned if a provider is submitting claims for all patients with the same CPT, and concerned if the documentation is exactly the same for every patient.

    It is an acceptable practice for a physician to allow the coder to review and make changes to the E&M code, but it would be best if the physician and the coder had a written document or policy stating this.

    We all know that ultimately the name on the claim is the person responsible for everything on the claim.

    Also, I would recommend you make the physician aware of what the NP is asking you to do, and get his/her approval prior to making any changes.
    Freda Brinson, CPC, CPC-H, CEMC
    2014 President AAPC Swainsboro, GA Chapter
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)
    brinsonfr@sjchs.org

  3. Default
    Hi Freda,
    This NP writes good and varies for each visit and even do counseling only that he just code for 99212 it seems like his scared of OVERCODING...

    ty

  4. #4
    Location
    Swainsboro/Statesboro, GA
    Posts
    753
    Default
    Sounds like the documentation would support a higher level in some cases, and if the NP is giving you permission to change the code, I would still get the physician's approval first.

    Even if the NP is scared of upcoding, allowing you to do it still makes the NP responsible. Sort of makes you wonder why the NP doesn't just code correctly the first time?!

    Good luck!
    Freda Brinson, CPC, CPC-H, CEMC
    2014 President AAPC Swainsboro, GA Chapter
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)
    brinsonfr@sjchs.org

  5. Default
    Thanks a lot,Freda I will follow your advise..

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