Im having a dispute concerning 99213 vs 99214 with a docter i work for. I code on an EHR system and he will not sign off on my codes because he does not believe im correct. I refuse to down code for fear of being audited and charged with fraud.
The problem is that the patient comes in for an ear infection, URI, etc. (first visit). I can either choose a selflimited or new visit w/o work up. I dont think these warrent a selflimited because they can not go away on their own, and the provider gives antibiotics. So I have a Moderate MDM, and usually a DT hx and exam (1997 standards are used for this EHR system).
How do I explain to this doctor that this is a 99214 visit? My boss has even sent out my coding to an outside sorce to get another opinion and they maintain its a 99214.
His claim is that "CMS clearly states that the documentation supports a code, but the visit determines it."
Does anyone know of documentation that explains this statement?
The problem is that the patient comes in for an ear infection, URI, etc. (first visit). I can either choose a selflimited or new visit w/o work up. I dont think these warrent a selflimited because they can not go away on their own, and the provider gives antibiotics. So I have a Moderate MDM, and usually a DT hx and exam (1997 standards are used for this EHR system).
How do I explain to this doctor that this is a 99214 visit? My boss has even sent out my coding to an outside sorce to get another opinion and they maintain its a 99214.
His claim is that "CMS clearly states that the documentation supports a code, but the visit determines it."
Does anyone know of documentation that explains this statement?