# ? downcoding from 99291



## cgulledg (Dec 2, 2010)

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.


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## faithdalton (Dec 2, 2010)

*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.


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## faithdalton (Dec 2, 2010)

*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.


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## FTessaBartels (Dec 6, 2010)

*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


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## PURNIMA (Dec 9, 2010)

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



cgulledg said:


> 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.


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## skrautkramer (Dec 9, 2010)

FTessaBartels said:


> 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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