Peer to peer billing

[PinchandBurn]

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I thought someone mentioned we can bill for peer to peer.


I feel like it takes me a good 20 min yoga have the call set up etc. Anyone recall the code?

Do you all add it on the procedure day or do u add it to the telephone encounter?

 

[MitchLevi]

Not sure why anyone would think this is a billable situation, especially a failed P2P.

 

[BoardingDoc]

It is billable, but is complicated and doesn't always work.

CPT Code for Prior Authorization May Still Happen -- Eventually

Proposal would cover more than existing codes for limited situations

www.medpagetoday.com

TL;DR: If you are doing a peer-to-peer or spending time on the phone for a PA for a patient you're seeing the SAME DAY, you can do your bill based on TIME instead of the usual collection of criteria. As such, if you saw the patient for 20 min and spent 25 min doing p2p nonsense, you can turn a 99213 into a 99215 based on 40+ min of time.

If it's done on a different day (much more likely) you can't do this.

The AMA was going to try to push for a code that you could bill for time spent doing PAs and P2Ps, but it never went to the proposed meeting in May.

 

[BobBarker]

You can make the patient come in for an office visit and do the p2p with them in the room.

 

[PinchandBurn]

It is billable, but is complicated and doesn't always work.

CPT Code for Prior Authorization May Still Happen -- Eventually

Proposal would cover more than existing codes for limited situations

www.medpagetoday.com

TL;DR: If you are doing a peer-to-peer or spending time on the phone for a PA for a patient you're seeing the SAME DAY, you can do your bill based on TIME instead of the usual collection of criteria. As such, if you saw the patient for 20 min and spent 25 min doing p2p nonsense, you can turn a 99213 into a 99215 based on 40+ min of time.

If it's done on a different day (much more likely) you can't do this.

The AMA was going to try to push for a code that you could bill for time spent doing PAs and P2Ps, but it never went to the proposed meeting in May.

Oh really!

I knew I had heard it. That's bs. You dhould.be able to bill for it....

 

[mdo1738]

You can make the patient come in for an office visit and do the p2p with them in the room.

^this. Also make use of 99358 or 99417

 

[SSdoc33]

Still not worth the time

 

[DOctorJay]

Still not worth the time

Have someone figure out why it was denied. Update documentation or tell patient to do therapy or whatever.

Stop wasting time on peer to peers.

 

[Welcome123]

Have someone figure out why it was denied. Update documentation or tell patient to do therapy or whatever.

Stop wasting time on peer to peers.

Unfortunately, there is much truth in this statement

 

[bedrock]

If it is a quick change sure, I just edit the note. Otherwise I do a peer to peer and the patient comes in for a visit at the same time. I bill a 99214 to their insurance company for wasting my time with this BS. I've also done telemeds at the same time as well.

 

[painfree23]

If it is a quick change sure, I just edit the note. Otherwise I do a peer to peer and the patient comes in for a visit at the same time. I bill a 99214 to their insurance company for wasting my time with this BS. I've also done telemeds at the same time as well.

What do u document in your 99214 note during the peer to peer?

 

[Status Sciaticus]

You can make the patient come in for an office visit and do the p2p with them in the room.

Have you had those P2P reviewers say they wont discuss it with the patients in the room/on speakerphone?

 

[BobBarker]

I asked the patient not to speak unless I asked her a question. So the p2p didn’t know the patient was in the room

 

[pastafan]

I wish that I had the patient in the room when a radiologist told me during a "peer to peer" that the procedure would not be authorized unless I got plain X-rays in addition to the MRI that had already been done. When I asked why she was requiring this I was told because it would provide more information than the MRI. You can't make this **** up.

I brought patient back for another visit, shot 2 views with my Fluoro machine, billed for visit and interpretation of X-rays.

 

[geauxg8rs]

I wish that I had the patient in the room when a radiologist told me during a "peer to peer" that the procedure would not be authorized unless I got plain X-rays in addition to the MRI that had already been done. When I asked why she was requiring this I was told because it would provide more information than the MRI. You can't make this **** up.

I brought patient back for another visit, shot 2 views with my Fluoro machine, billed for visit and interpretation of X-rays.

You should ask for the page and paragraph of their guidelines where X-ray is required.
It’s like when guidelines ask for 6 week of pt prior to injection. I document that patient has done 6 weeks pt. Then gets denied. I do peer to peer and i am sure that someone just didn’t see my note saying they did the 6 weeks. Then the doc tries to ask for actual pt notes. I reply with

“I want the page and paragraph in your guidelines that require these notes. I have read your guidelines and see no mention of needing to supply pt notes. So if this is not approved I will go to state insurance commissioner and medical board with your name as unnecessarily delaying appropriate medical care.”
100 percent approval rate at that point