tci E/M Coding Alert - 2016 Issue 3

Medicare News: Medicare Payer Reports Problems with 99215 Use

Jump any high-level claim hurdles you might encounter with this advice. NGS Medicare recently made headlines with its report on pre-payment reviews, particularly high-level E/M services. The basics: NGS performed a pre-payment review on code 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity) for claims submitted between October and December of 2015, and in early February 2016, the payer revealed that over 65 percent of the claims for this code...

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