Wiki neurology E&M

[SSweetland]

I am seeing an increase in denials from our Medicaid carrier on 99214 E&M visits in neurolgy. When I audit them, I am finding that the notes are still coming out to 99214 and have been appealing them. Did something change within that past 3-4 months with coding E&M codes in neurology. The carrier stated they use psych codes but I am new with neurology and not understanding this. The note is not always pertaining to Psych. Can someone please give me a direction to go with this. thanks

 

[pclaybaugh]

I am seeing an increase in denials from our Medicaid carrier on 99214 E&M visits in neurolgy. When I audit them, I am finding that the notes are still coming out to 99214 and have been appealing them. Did something change within that past 3-4 months with coding E&M codes in neurology. The carrier stated they use psych codes but I am new with neurology and not understanding this. The note is not always pertaining to Psych. Can someone please give me a direction to go with this. thanks

Our facility uses the '97 specialty exam for our neurologists, hospitalist as well as office. So, not knowing what portion of the E&M is not meeting, hard to judge. Our providers are encourage not to lump the cranial nerves together. This is an established office code, so take a peek at what's required to meet a 99214 and encourage your provider to use those exam elements. Perhaps the medical decision making and data points don't add up either.
I'm not sure what your carrier means by psych codes.

 

[SSweetland]

thank you so much for your response.

 

[navinm42@gmail.com]

I am seeing an increase in denials from our Medicaid carrier on 99214 E&M visits in neurolgy. When I audit them, I am finding that the notes are still coming out to 99214 and have been appealing them. Did something change within that past 3-4 months with coding E&M codes in neurology. The carrier stated they use psych codes but I am new with neurology and not understanding this. The note is not always pertaining to Psych. Can someone please give me a direction to go with this. thanks

Psych evaluation is not a integral part of neurolgy exam. Check if your provider is doing related to psych evaluation.