Primary Care Coding Alert

E/M Services:

Double Check Documentation Before Dropping from 99204 to 99203

You're not only losing revenue -- you're also coding improperly.If your coders are sometimes tempted to report 99203 instead of CPT 99204 (or 99213 instead of 99214) to "be on the safe side," you might not be so safe after all.National insurer data from previous years shows that medical practices undercode E/M claims to the tune of over $1 billion annually. That's money that physicians could have collected based on their documentation, but forfeited because they reported a lower-level code than they should have. Your responsibility is to code based on your physician's documentation -- but don't fall into the trap of downcoding just to be "on the safe side."Could You Be Triggering an Audit?The top reason many practices undercode is because they don't want to "trigger an audit." However, coding all low-level E/M codes is sure to get a payer's attention, because the claims reviewers will be wondering why you never [...]
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