mzblackmon12@gmail.com
Networker
Do any of you have a hard time trying to explain to your derm that just because they do a complete body exam of the skin they cannot ALWAYS charge a level 5? Any suggestions??
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Wiki Always a level 5 ! ! ! ! ! !!
- Thread starter mzblackmon12@gmail.com
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AprilSueMadison
Expert
Well, for an existing patient they must meet or exceed two out of three of the requirements for any exam. My doctors were SURE they met 99204 and 99214 for various patients and we'd go back and forth about it for a bit. What I finally ended up doing was printing out the documentation, taking an audit tool (that I had previously gone over with them) and underlining all of the bullet points and using that tool to get to the code.
I had to do this multiple times, but using that as an education method really worked and they have a much better understanding of when they can reach the higher codes and what I'm looking at.
But yeesh...99215? I'm sitting here contemplating what my providers do and maybe mine are different and other derms do...but I can't even fathom how they'd hit a 99215. Maybe they would meet MDM, but as for the history or exam...I just don't think mine ever would.
I had to do this multiple times, but using that as an education method really worked and they have a much better understanding of when they can reach the higher codes and what I'm looking at.
But yeesh...99215? I'm sitting here contemplating what my providers do and maybe mine are different and other derms do...but I can't even fathom how they'd hit a 99215. Maybe they would meet MDM, but as for the history or exam...I just don't think mine ever would.
CatchTheWind
Guest
I agree with aprilsue. I have worked for multiple dermatologists for several years and have never, ever, coded a level five! It is essentially impossible for a dermatologist to get this level unless he is spending extensive time counseling and then billing based on time.
As aprilsue suggested, show them by use of an audit tool what level they are actually reaching. Even with the full skin exam, they are often only going to reach a level 2 or 3, and never higher than a 4.
I would warn them that if they consist in upcoding, they are inviting and audit, huge take-backs, and possible fines.
As aprilsue suggested, show them by use of an audit tool what level they are actually reaching. Even with the full skin exam, they are often only going to reach a level 2 or 3, and never higher than a 4.
I would warn them that if they consist in upcoding, they are inviting and audit, huge take-backs, and possible fines.
mitchellde
True Blue
Another point to look at and one that the OIG mentioned in their work plan was the issue of time. In other words a 99215 is a 40 minute encounter on average just to perform the key components. If every one or even the majority are a 99215, then how much time is a single provider billing for really in a days time. Because a single provider could only have 12 patients in a given 8 hour day with no breaks in between. If you exceed the realm of possibilities then that will be a problem.
CatchTheWind
Guest
Very good point, Debra!
T Roberts
Guest
Try Debra's mathematical equation to their work day. I am sure they are not interested in an OIG audit.