Denial for 99214

Question:

I work with Dermatologists. I have taken a couple of your online webinars. I have a question regarding a denial of office visit 99214, I hope you can answer. The denial indicates that medical records do not support the level of service. In that type of situation, can we rebill the claim as a corrected claim to a 99213?

Answer:

I would not just change the coding to 99213 without reviewing the documentation first. In 2021 the guidelines for office or other outpatient E/M services changed in that either time or medical decision making determines the level. Of course a clinically relevant history and examination should be documented. I would review the note for the date of service denied and code the encounter based on the documentation and not just assume 99213 is the correct code to report. If you need E/M training for Dermatology KZA can help provide education to you and your dermatology practice on coding and documenting E/M services.

*This response is based on the best information available as of 11/17/22.