Re: New E&M Evaluation and Management Guidelines Documentation Compliance

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This message is from PedTalk! To reply to the group, use "" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ At 11:42 AM 10/25/97 -0600, Maria K. Todd wrote:

> Coding and Documentation Guidelines. I finally got a hard copy of
>the 50+ page document, plus there are also requirements for ordering
>certain lab tests(another 50 or so pages).
>
>Having been involved in expert witness defense of physicians for fraud
>and abuse, I urge you to please digest this E&M guideline document and
>its compendia and ask questions- there are no stupid questions here...
>this is really serious @#$%^!!!

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Maria,

Thank you for a really helpful post.
Three @#$%?!!! questions:

1) Since downcoding will also now be an offense, what do we do if we want to give a family a discount if the whole visit charge will be applied to the child's deductible. In the past I might have billed a 99213 as a 99212 and charged the 99212 fee. So now should we bill and charge the insurance for a 99213 then write off the difference so the family only pays the charge as if it were a 99212? I thought insurance companies also frowned on billing them and the patient two different amounts.

2) Are these guidelines and penalties only applicable to medicare and medicaid, or will they apply to all insurance plans?

3) What about someone who's uninsured? I ask this because my office manager's mother was grossly overcharged for an emergency room visit. The doctor significantly upcoded the visit and also charged for a venipuncture and starting an IV, procedures which were performed by a nurse. Would the ramifications of this be different after Jan 1st?

Thank You,

Michael Sachs, M.D.