tci Part B Insider - 2016 Issue 5

E/M Coding: NGS Medicare: Majority of 99215 Claims Were Coded in Error

Use our expert tips to avoid the issues that plagued high-level claims. When payers announce that they’re planning to run pre-payment reviews, many practices never find out what results were gleaned from the audits. In the case of Part B payer NGS Medicare, however, several recent audits have become an open book—and the results were startling. NGS performed a pre-payment review on code 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making...

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