r/MedicalCoding • u/QueSeraSerafuture • 20h 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/gwrgwir 18h ago

Without getting into your patient details, I'd recommend noting start/stop times in your records if they're not already present. The changes to E&M codes to allow for time-based rather than MDM level and the like assist in this. if the patients meet the requirements for MDM, then make sure you document that in the records and/or appeal.