tci Medicare Compliance & Reimbursement - 2013 Issue 24

Reader Question: Not All Follow-Ups Are Created Equal

Question: We recently finished our first internal audit and found a potential issue: One of the doctors told me that he only chooses level 99212 when it is a follow-up from a previous visit. He chooses levels 99213 and above for everything else. I do not believe it is that simple because I thought even if it was not a follow-up visit, something like a minor cold might warrant 99212. Can you advise? Answer: You are correct. Not only can a follow-up problem-oriented visit for an established patient warrant a “low-level” code such as 99211 or 99212, but...

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