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Old 06-15-2018, 11:01 AM
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Default Wow, upcoding

So it's been a while since I've really had medical claims. I established myself as a new patient at a clinic and had one follow-up telemedicine appointment. Neither lasted more than 10 minutes. Arguably, the doctor read over my intake forms for 5-10 minutes.

Both were coded as 99205, 99215 (high complexity, 60 minutes).

Also, I started doing some therapy and a 30-minute visit was coded as 60 minutes.

What a flipping scam. I'm sending message after message fixing these claims.

Have you had a similar experience?
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Old 06-15-2018, 11:10 AM
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Oh yes, knowing about coding really opens your eyes. This happens all the time.
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Old 06-15-2018, 11:59 AM
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This happens absolutely all the time. Then insurance companies get blamed for all the high costs.
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Old 06-15-2018, 01:26 PM
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Originally Posted by ActurialMike View Post
This happens absolutely all the time. Then insurance companies get blamed for all the high costs.
What can we do about it?

And what does this mean for those providers who refuse to upcode? How can we keep them from being penalized because of the offenders?
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Old 06-15-2018, 01:43 PM
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Problem for insurers is that there is a lot of it going on (lots of tiny needles, not a sword slash causing the bleeding), and without the patient (like mm) noticing or even knowing how to notice it, this fraud is not going to get identified.
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Old 06-15-2018, 01:47 PM
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Most of my bills don't have any codes on them. Are you requesting more detail?
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Old 06-15-2018, 02:03 PM
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Most of my bills don't have any codes on them. Are you requesting more detail?
My patient portal has CPT codes.

Oh, oh, I got a drinking and depression screening (billed charge $40 each) without us even talking about it! (The forms I filled out had checkboxes. Sketchy though.)
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Old 06-15-2018, 02:05 PM
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What can we do about it?

And what does this mean for those providers who refuse to upcode? How can we keep them from being penalized because of the offenders?
I mostly am taking notice because I'm in an HDHP and paying for office visits. Those with copays may not know or care.

However, the payment is through the insurer as it must be after the claim is adjudicated. All this is coming out of my HSA. Of course I'm going to care. And yes you can tell the insurer to go back and review.
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Old 06-15-2018, 02:45 PM
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Absolutely!

MedLogic, amiright?
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Old 06-15-2018, 02:48 PM
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It does seem like this could be included in call campaigns and/or patient satisfaction surveys- simply asking the patient "how long would you say your appointment lasted?" and comparing to the code.

Although, I don't know that I would even know how long I was at my last PCP visit for.
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