Med Management billing question (outpatient only)

[milesed]

I'm being told by our billing department that we are not able to bill for any service higher than 99213 for established and 99203 for new patients. It started with Medicaid/MCO's and now they say it also pertains to Medicare and private insurance companies. Is this possible?

I thought the coding changes that took effect a few years ago were to help with parity. This seems like a huge step back if it's true. Are you all being paid for 99214, 99215, 99204 and 99205 level visits?

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[splik]

I bill almost all new visits as 99205 (unless patient is late). sounds like complete nonsense. how much time do you get for new intakes? what about follow ups? I usually bill 99213 + 90833 or 99214 for follow ups (30 mins)

my understanding is CMS is only scrutinizing overuse of level 5 codes. however if you see a patient who requires hospitalization the level of complexity/severity, and time (certainly going to take 40 mins to sort out) would justify 99215 billing. remember under coding is just as fraudulent as over coding.

 

[Information Underload]

I would question the veracity of this information. Are they confusing inpatient coding for outpatient? There are only 3 levels for inpatient, which might explain the confusion. I have heard nothing about CMS saying you can't bill a level 4. By their own definition, this would be fraud.

If you have a follow-up patient with generalized anxiety disorder, major depressive disorder, and insomnia, did a medically appropriate interview, recorded this interview, and are prescribing medications (really, it doesn't even matter about prescribing medications), it would be undercoding to bill for anything less than a 99214 (if you are the one managing these conditions). It doesn't matter how stable the patient is.

It would be extremely difficult to code for a 99203 for most psychiatric patients--at least the ones who I see. The bare minimum number of problem points you are looking at is 3 (because it's a new problem to you), which is moderate level medical decision-making. Thus, to get a 99203, you are looking at a patient with one stable chronic psychiatric condition with no collateral data who you prescribed an over-the-counter medication or referred to a therapist. If you're prescribing a prescription medication to a patient or keeping them on their current medications, you're at 99204 level provided the rest of your exam passes muster.

 

[F0nzie]

Our billing department says no to 99215s because of audits. 99214s are still OK.


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[wolfvgang22]

Most of what I bill is either 99214 or 99213 follow ups with some 99205 initial evals. These are 30 min follow ups and 1 hour new evals. I bill a 99212 very rarely and 99215 almost never.