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use of Ecodes in pediatric and insurance outpatient resourses

  1. #11
    Traverse city/ Detroit
    Medical Coding Books
    Thank you all for all the advice

    I am very thankfull that i found this job after getting my certifcaition with no experience. So I do mention coding guildlines to the office manger who is very understandable and is a great lishner, but I cant use some of things like the follow ........

    1)E-codes - never use.

    2) Med Checks - 90805 and 90862 only priority health all other ins bill as 99214 or 99215 becuz they wont pay for it. And sometimes the documentation does not support 99214 or 99215 which then i point out, she tells me to bill it and wright down the pts name and she will inform the dr. Im not really sure if the dr goes back and documents?

    This is really bothering me I do have a job evalution coming up and I will mentioning these issues again but maybe more firmly........I dont wanna lose my job so ill be very pleasent LOL.

    I have documention about E-codes and E/M codes Any ideas where abouts i can get documention on med checks?



  2. Default
    I'm at my second place of employment since I've gotten my CPC and I've used E-Codes in both places for anything that comes through that's supposed to have it by the official guidelines. We actually have a report now at my current job that tells us which patient's have diagnosis codes that still need an E-Code attached to it for completion in order for it to be billed. So it's a requirement where I'm at now. I also know that some payors to over look it, but I don't think it really hurts to have it either...

  3. #13
    On the med checks... if the Doctor spends more than 50% of the office visit counseling the patient then you can code based on time for the 99211-99215 the trick is getting the doctor to notate time and % of time spent counseling. Another thing I would recommend is making sure you have your resources handy when discussing these things with the office manager... you will come across as very professional if you are able to state your position and then back it up with printed resources. You should also remind her that you are just concerned for the office in case of an audit and as a Certified Coder you feel it is your responsibility to point things out to her that are not in line with CMS Guidelines. A Wonderful resource for you would be the American Academy of Pediatrics Coding for Pediatrics book for 2009. I get a new one every year along with my coding books... the help it has given me has been immeasurable.

    Take care... We are in the busy season in my office and I am not always in the forums but feel free to send me a private message if there is anything I can help with... coming from an office where I am the first and only coder on staff I feel your pain. I have initiated a lot of changes in my office just by doing what I said above... it's hard for them to argue with your position if you can show it to them in black and white.
    Barbara Haskins CPC

  4. #14
    Default ahansen,CPC
    I use to be a biller before I became a became a coder.
    So I am very familiar with the denials for the different insurances.
    Now that I am a coder I always add the E-codes when appropriate.
    One day I heard one of the billers rant and rave because we were using e-codes and she
    was trying to get us coders to stop. So I asked what the denial
    reason was, her not knowing, I took it upon my self to call the Payor
    BCBSIL. Their program is not set up to take e-codes. So it was not
    that we were wrong in billing the e-codes. So for this payor we put
    the e-codes in the notes. So each payor may have similar problems.
    It is always best to find out why the payor is dening the claim.

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