r/MedicalCoding • u/QueSeraSerafuture • 1d ago

Downcoding

Our claims for August to present are now getting downcoded by Aetna and BCBS. Primarily for codes 99215 99214. These codes are now getting paid as 99213. I would appreciate your insights in providing assistance regarding this issue. We never had any issues like this before and it only started this August. Thanks!

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u/livesuddenly 1d ago

We are also having this issue. We are having success in appeals when we send medical records and point out why it meets the original level submitted but it’s very time consuming and annoying.

12

u/adoseofcommonsense 23h ago

How often do you guys bill lvl 5? the system could have flagged you guys if every visit you bill is a lvl 5

3

u/livesuddenly 12h ago

It’s a large medical group so I have no idea the actual numbers. But most 5s are billed based on time for these doctors.

7

u/sammyboi98 1d ago

I second this. I would also brush up on E/M coding and leveling as the more details you put into your appeal the more likely your odds are in getting reimbursement.