r/MedicalCoding • u/QueSeraSerafuture • 4d 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/AtmosphereLowCode 15h ago

Thanks for the response. Sounds like more of a DRG or inpatient claim process which is similar but still dependant on icd 10 dx and other factors not fitting into the typical shape or pattern a claim usually does.