Usually physician upcoding their services but unusually some physicians are undercoding their services and loose their money. Its because of many reason.
1. “Some physicians will code every office visit as a 99212 just to stay under the radar and avoid a Medicare audit,” says Ginny Martin of Healthcare Consulting Associates of NW Ohio in Waterville. “However, coding everything the same can initiate an audit as well.”
2. Medicare data suggests that, for evaluation and management services, overcoding is far more common. Medicare providers overcode with the ubiquitous 99213
3. “Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code.”
4. For a 99214, the nature of the presenting problem(NPP) is usually of a moderate to high severity, in contrast to a 99211, where the NPP is usually minimal. Pinning down the NPP level is the key to accurate coding
5. Arrive at a tentative NPP as part of your differential diagnosis once they take a comprehensive history. We use 3 gen pedigree and extensive social history. Include a field for the NPP on your hard-copy encounter form or in your EMR
6. Use the whole ICD9 Code: “I’m stunned by how many doctors don’t do that. A 250.00 means Type II diabetes that’s under control. What if it’s not under control? That’s 250.02.”
So to summarize, use the right code, be realistic with your encounters and make this PART OF YOUR CLINICAL PRACTICE. By using these, you begin to scrape away the magic of the billers and coders…..How do you do this? Keep reading, we’ll get there.
