downcoding

  1. C

    Reducing the Level of Service / E&M

    Hello. I would appreciate hearing others thoughts on the following issue please. Is there one correct answer? Scenario: CPT 99214 billed. Carrier requests records for a pre-payment review. OV notes are submitted. Carrier reviewed the records and denied the E&M as level of service not...
    • cling2me2
    • Thread
    • downcoding e&m level
    • Replies: 4
    • Forum: E/M
  2. M

    Wiki Sleep Medicine Billing- Split night

    Hello, Is anyone experiencing issues with sleep medicine billing when a split-night study (95811) is ordered but does not meet split-night criteria? Many insurance companies are denying these claims and refusing to allow a downcode to a diagnostic study (95810). How are billers addressing this...
  3. M

    Wiki Molina is automatically downcoding office visits without requesting medical records.

    I do billing for an internal medicine physician who specializes in weight management. Most of his visits are coded as 99214 or 99215 + 99401 or 99402. We do not have a lot of Molina patients, but of the ones we do have, every single claim gets downcoded from 99214 to 99213. We do not receive a...
  4. S

    Wiki Downcoding Lab Services

    We are an independent lab. Humana and Cigna now have policies in place that they will not reimburse any higher than a G0480 tox for Humana and a G0481 tox for Cigna. What Cigna does is downcode when they reimburse and Humana pays the higher tests than recoups a couple months later and we have to...
  5. G

    Wiki E/Ms Being Downcoded by Insurance Company

    Hello, Is anyone experiencing downcoding of EM's by Horizon Blue? If so, can you share how you are handling this? We have audited these charges, sent records to the insurance company but have not gotten little feedback on what the problem is. They are downcoding Level 4s & 5s to Level 3s. We...
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