Q&A: Will Using Lower Level Codes Reduce Our Chances of Being Audited?

by  ChiroCode™
Jun 16th, 2016 - Reviewed/Updated Mar 5th

Question:

If we use low level codes on each visit (such as 98940, 99212, 99202), will our chances of being audited be less than if we billed higher level codes?

Answer: 

No. There is no such thing as "under the radar".

Documentation and coding must tell the same story, so it is essential that your selected codes be clearly demonstrated and fully supported within the patient documentation.

Under-coding can pose an obstacle to practices as well, and result in further investigation of billing and documentation.

Remember too, that payers evaluate trends and statistics. Your use of codes is compared to your peers. If your practice appears to be using particular codes at a significantly greater or lesser frequency of other practices that offer the same services, this could potentially be a "flag" that would prompt a payer to more closely monitor your claims or conduct an investigation.