Forum - Questions & Answers

Nov 17th, 2015 - sschwartz 4 

Chearging an E&M in place of a procedure

Carging an E&M in place of a procedure

Nov 17 2015, 1:12 PM Can a Provider legally charge a low E&M in place of a procedure code to save the patient money? Also can they charge a nure only 99211 for the initial visit? We are a Rural Health clinic and from all I've found a 99211 is strictly a nurse only level and Medicare does not recognize it as an encounter. In this case the provider wants to charge a 99211 for the initial visit and then a 99213 for the removal of some moles. Is that legal?

Nov 17th, 2015 - KIMESPINOSA 2 

re: Chearging an E&M in place of a procedure

Do you have a sliding fee schedule? We are a RHC as well as a FQHC and our patients fees are slide based on the poverty lever. The provider should not charge a lower E&M code just to justify fee.

If anything there should be a policy and procedure in place to discount but not to code a lower level especially when the documentation meet the higher level of code.

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