DRG Coding Advisor
Carriers told to focus on two CPT codes
The Health Care Financing Administration is telling Medicare carriers to pay extra attention when reviewing claims to the documentation used by physicians who bill two particular Current Procedural Terminology (CPT) codes.
The codes in question are: 99233, used for subsequent evaluation and management (E/M) of hospital patients, and 99214, for high-level subsequent physician office visits.
Looking for the connection
HCFA wants to see a direct connection between the code and the documentation used to justify it, say reimbursement experts. Translation: Don’t just assume because your patient is very sick, Medicare is going to accept your word that he or she required the highest level of service.
Judgment aside, auditors are going to want an itemized bill and documentation showing something like three hospital visits — or one to five physician office visits — to justify a 99233 code.
Solid documentation is also going to be needed when billing a CPT 99214 level office visit. For instance, it’s recommended that you show at least two of those three components: detailed history and/or detailed exam and/or medical decision making of moderate complexity.
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