Guest guest Posted October 5, 2010 Report Share Posted October 5, 2010 Hello all, Has anyone gotten one of those letters from an insurer telling him/her that their coding is higher than their peers? Or the letter from Medicare citing that they are planning a probe on the use of 99214 in family medicine practices? If so, how did you respond? Can't be in Denver this week due to $ and time....oh well... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 5, 2010 Report Share Posted October 5, 2010 Hi JMBMD2007, ‘Bring it on’ is how I responded, but in a more PC way of course. If you spent the time and met the coding criteria and documented it, you have nothing to fear, except the stupidity of the insurance companies. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of jmbmd2007 Sent: Tuesday, October 05, 2010 8:40 AM To: Subject: Coding warnings Hello all, Has anyone gotten one of those letters from an insurer telling him/her that their coding is higher than their peers? Or the letter from Medicare citing that they are planning a probe on the use of 99214 in family medicine practices? If so, how did you respond? Can't be in Denver this week due to $ and time....oh well... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 5, 2010 Report Share Posted October 5, 2010 I've never understood the " code to peers " thing. When I've told other providers that 60-80% of my E/M codes are level 4 (even while working as a hamster), they say that I should be coding like everyone else. I tell them that I code to CPT standards, not peer standards. This peer thing is one of the most ridiculous things I've seen. I can only see it as an attempt for insurance companies to decrease expenses by maintaining the chronic undercoding of providers. Anyway, I always code per the CPT guidelines and not by what other people do. I have survived all audits w/o questions b/c I document based on CPT requirements. I even format my notes so it is very clear how many hx bullets, ROS bullets, PMFS hx items reviewed, PE bullets, and clearly state my medical decision making including all the requirements if I use time as the reason for the CPT code. It is very easy to code when I do this. Craig > > Hi JMBMD2007, > > > > 'Bring it on' is how I responded, but in a more PC way of course. If you > spent the time and met the coding criteria and documented it, you have > nothing to fear, except the stupidity of the insurance companies. > > > > Eads, MD > > Pinnacle Family Medicine > > Colorado Springs, CO > > www.PinnacleFamilyMedicine.com > > > > > > > > From: > [mailto: ] On Behalf Of jmbmd2007 > Sent: Tuesday, October 05, 2010 8:40 AM > To: > Subject: Coding warnings > > > > > > Hello all, > > Has anyone gotten one of those letters from an insurer telling him/her that > their coding is higher than their peers? Or the letter from Medicare citing > that they are planning a probe on the use of 99214 in family medicine > practices? If so, how did you respond? > > Can't be in Denver this week due to $ and time....oh well... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 5, 2010 Report Share Posted October 5, 2010 I agree. I think it is just a way to identify outliers who are possibly not coding correctly. But code what you do, don't downgrade yourself.Same with IRS deductions. Don't cheat yourself....you can survive an audit (at least I hope I can)... Just document.SharonSender: Date: Tue, 05 Oct 2010 17:24:00 -0000To: < >ReplyTo: Subject: Re: Coding warnings I've never understood the " code to peers " thing. When I've told other providers that 60-80% of my E/M codes are level 4 (even while working as a hamster), they say that I should be coding like everyone else. I tell them that I code to CPT standards, not peer standards. This peer thing is one of the most ridiculous things I've seen. I can only see it as an attempt for insurance companies to decrease expenses by maintaining the chronic undercoding of providers.Anyway, I always code per the CPT guidelines and not by what other people do. I have survived all audits w/o questions b/c I document based on CPT requirements. I even format my notes so it is very clear how many hx bullets, ROS bullets, PMFS hx items reviewed, PE bullets, and clearly state my medical decision making including all the requirements if I use time as the reason for the CPT code. It is very easy to code when I do this.Craig>> Hi JMBMD2007,> > > > 'Bring it on' is how I responded, but in a more PC way of course. If you> spent the time and met the coding criteria and documented it, you have> nothing to fear, except the stupidity of the insurance companies.> > > > Eads, MD> > Pinnacle Family Medicine> > Colorado Springs, CO> > www.PinnacleFamilyMedicine.com> > > > > > > > From: > [mailto: ] On Behalf Of jmbmd2007> Sent: Tuesday, October 05, 2010 8:40 AM> To: > Subject: Coding warnings> > > > > > Hello all,> > Has anyone gotten one of those letters from an insurer telling him/her that> their coding is higher than their peers? Or the letter from Medicare citing> that they are planning a probe on the use of 99214 in family medicine> practices? If so, how did you respond?> > Can't be in Denver this week due to $ and time....oh well...> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 5, 2010 Report Share Posted October 5, 2010 Craig, Same here. I code to CPT guidelines. No problems in 10 years. from the Barrio I've never understood the "code to peers" thing. When I've told other providers that 60-80% of my E/M codes are level 4 (even while working as a hamster), they say that I should be coding like everyone else. I tell them that I code to CPT standards, not peer standards. This peer thing is one of the most ridiculous things I've seen. I can only see it as an attempt for insurance companies to decrease expenses by maintaining the chronic undercoding of providers. Anyway, I always code per the CPT guidelines and not by what other people do. I have survived all audits w/o questions b/c I document based on CPT requirements. I even format my notes so it is very clear how many hx bullets, ROS bullets, PMFS hx items reviewed, PE bullets, and clearly state my medical decision making including all the requirements if I use time as the reason for the CPT code. It is very easy to code when I do this. Craig > > Hi JMBMD2007, > > > > 'Bring it on' is how I responded, but in a more PC way of course. If you > spent the time and met the coding criteria and documented it, you have > nothing to fear, except the stupidity of the insurance companies. > > > > Eads, MD > > Pinnacle Family Medicine > > Colorado Springs, CO > > www.PinnacleFamilyMedicine.com > > > > > > > > From: > [mailto: ] On Behalf Of jmbmd2007 > Sent: Tuesday, October 05, 2010 8:40 AM > To: > Subject: Coding warnings > > > > > > Hello all, > > Has anyone gotten one of those letters from an insurer telling him/her that > their coding is higher than their peers? Or the letter from Medicare citing > that they are planning a probe on the use of 99214 in family medicine > practices? If so, how did you respond? > > Can't be in Denver this week due to $ and time....oh well... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 5, 2010 Report Share Posted October 5, 2010 The peers are wrong, shown over and over. Never heard of the MDc thing. If you document you should be alright ________________________________________ From: [ ] On Behalf Of jmbmd2007 [jimbury@...] Sent: Tuesday, October 05, 2010 8:39 AM To: Subject: Coding warnings Hello all, Has anyone gotten one of those letters from an insurer telling him/her that their coding is higher than their peers? Or the letter from Medicare citing that they are planning a probe on the use of 99214 in family medicine practices? If so, how did you respond? Can't be in Denver this week due to $ and time....oh well... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 7, 2010 Report Share Posted October 7, 2010 You can bill for time on new patients the times are just longer, and are still 50% of the visit.New Patients90201-10 minutes90202-20 minutes90203-30 minutes90204-45 minutes90305-60 minutes From: [ ] On Behalf Of Eads [michelle.eads@...]Sent: Wednesday, October 06, 2010 8:04 PMTo: Subject: RE: Re: Coding warnings True for new pts – can’t code based on time. But you can code based on time for established pts if they meet the other criteria, which is usually not hard as the folks taking up that much timeusually have enough issues involved, rxs to be managed, etc, to justify it. 99214 is for > pt = 25 minutes, and 99215 is for > pt = 40 minutes. http://www.aafp.org/fpm/2005/0900/p52.html From: [mailto: ]On Behalf Of Dr LevinSent: Wednesday, October 06, 2010 5:17 PMTo: Subject: Re: Re: Coding warnings  If you spend the " time " but the seriousness of the problems are NOT life threatening, I think you're looking for a pack of trouble billing 99215 or 99205 for a new pt........ Coding warnings> > > > > > > > > > > > > > > > > > Hello all,> > > > > > Has anyone gotten one of those letters from an insurer telling him/her> > that> > > their coding is higher than their peers? Or the letter from Medicare> > citing> > > that they are planning a probe on the use of 99214 in family medicine> > > practices? If so, how did you respond?> > > > > > Can't be in Denver this week due to $ and time....oh well...> > >> > > > > >> Quote Link to comment Share on other sites More sharing options...
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