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Posts: 4
Reply with quote  #1 

You give examples of 99214 + psychotherapy add on, noting that 99214 is the most used code for office outpatient. My colleagues tell me that they fear that they will be audited if most of their notes are 90214 + psychotherapy (even though they did 99214 level work & it was medically necessary). As a result, they are using 99213 + psychotherapy.

Do you have any opinion or recommendation regarding this? Do you have any opinion or suggestions about whether to use 99213 vs 99214 when a psychotherapy add-on is used (when a 99214 would ethical to bill for if there were no psychotherapy add-on)?

Thank you

Sandy Stevens

Posts: 49
Reply with quote  #2 
As long as medical necessity exists and the key components of E/M are satisfied, 99214 could be supported. Providers whose benchmark shows an outlier of 99213 are every bit prone for audit as those who report 99214. 
Sandy Stevens, CPC, CPMA
Reply with quote  #3 
Why being afraid of being audited if we document correctly? I just started working with psychiatrist who gets audited frequently but never sanctioned because she is documented it correctly. I have read some of her notes and they are sometimes very short. It is not the amount but the quality.
Reply with quote  #4 
An error is an error in terms of auditing. So it doesn't matter of they undercover or overcode. The government still sees it as an error and they don't see down coding as a good thing.

If the medical necessity for a 99214 is documented and all other criteria support the code and the psychotherapy code...they should bill both. The duty we have is to educate physicians to help them report the appropriate code (s).
Reply with quote  #5 
It is just as easy to be audited for undercoding as overcoding. If it is believed that a provider is undercoding, it raises the question of, "are they purposely keeping out of pocket expenses down for indigent patients", or "are patients truly receiving care that they require". If the documentation supports what they provider did during that encounter, they should bill out the proper E/M for that level of service.
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