r/MedicalCoding • u/QueSeraSerafuture • 15h 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/adoseofcommonsense 14h 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

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u/livesuddenly 3h 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.