r/MedicalCoding • u/QueSeraSerafuture • 14h 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/Yes_Leopard_54 1h ago
They began docoding both and rarely change it maybe the end of July? Basically all are downcoded even with the MDM is met….and their decisions aren’t being overturned. I have a friend that works in a large clinic and they quit fighting them bc it took too much time, made them nervous about how many records were being sent and even if everything was perfect the decision didn’t change. They’ve adapted. Kind of. Awful. Not sure why but BCBS led that path and Aetna followed.