Wiki UHC Denials

[kguzikowski]

UHC is many times requests medical records on submitted Inpatient hospital claims. Our physicians are Nephrologists, so most of the patients we see are requested consultations.
We are billing 99222, or 99223. Upon request we send the records which is sometime 10-12 visits. Most of the time it comes back with all visits supported and the Initial Consultation
denies 99222, or 99223. Indicating that the initial consultation E/M requires a comprehensive history, a comprehensive exam and medical decision of modern complexity.
At which point choice is to down code, or submit an appeal.

Not sure best how to present question, but here goes:
What are some bullet points I can give to my physicians to improve documentation?
Fighting UHC any Tips for those who have encountered this problem?
Has AAPC ever done a presentation regarding this type of payer related issue?
Please send any feedback you may have, thanks

 

[thomas7331]

It's kind of a moot question at this point. There are (or were) some good tools for helping provider documenting history and exam, however these are of little use now with the 2023 code changes for this year where only time and MDM will be used. It's probably early for new tools to have been developed, but I think your task is much easier now in that you just need to focus on having the provider's track and document their time and/or the complexity of their decision making.