Wiki Have to Share this

[Gemini18]

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.

 

[ollielooya]

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

 

[CRC CPC]

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.