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Thread Topic: upcoding for writing an RX
Topic Originator: Sandy
Post Date May 9, 2011 @ 3:39 PM
upcoding for writing an RX


Sandy
May 9, 2011 @ 3:39 PM Reply  |  Email Friend   |  |Print  |  Top

One of the Doctor's I work for thinks you can up an E&M code because she wrote an RX.  So she did an 99212 but wants to have it coeded a 99213 because she wrote an RX.  This doesn't seem right to me.  Has anyone ever heard that this is acceptable?

Steve Verno, CMBS, CMSCS, CEMCS, CPM-MCS
May 9, 2011 @ 8:55 PM Reply  |  Email Friend   |  |Print  |  Top

WE NEVER, NEVER, NEVER, NEVER NEVER, UPCODE.  AND WE NEVER CODE FOR THE PURPOSE OF INCREASING REVENUE.  WE DO NOT SUPPORT FRAUD IN ANY FORM.  

His 99212 could be a 99211 if his documentation doesnt meet the standard for a 99212.  

We can never approve an E/M level without looking at the medical record and there are NO what ifs.  You must see the documentation.  

If he wants to charge a 99213 but his documentation only supports a 99212, is he ready to become a member of the State Department of Corrections?  Instead of wearing a white lab coat, can he accept an orange jump suit?   Writing a prescription does not automatically make a visit a 99213, 99214, or 99215.  A prescription would be part of the Medical Decision Making under Risk.

The simple answer is to follow the 1995/1997 Evaluation and Management Documentation Guidelines with the E/M guidelines out of the CPT manual.   If the visit was an office visit and his documentation supports a 99212, he shouldnt be thinking, "If I do this, can I charge a 992XX?"  Thats not the business we're in.  Our patients are not our personal piggy bank.

I personally know three doctors who treated me and who may lose their medical license for (1) upcoding the visits, and billing for services not requested and not documented.    All 3 charged for consults and one charged a consult and a level 5 office visit.  

WE MUST COMPLY WITH CURRENT CODING AND DOCUMENTATION STANDARDS AND GUIDELINES.  If we dont, we're in the wrong profession.



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