99215

We have a doc that likes to charge mostly 99214's and now he is wanting some 99215's billed on Medicare patients.
The documentation is there (or close) to meet the history & exam, but I don't see the medical necessity to bill that high of a level.
However, he insists that the physician should decide if the visit is medically necessary or not. Any advice? I think Medicare is currently auditing 99215 visits & I don't want to code a higher level than medically necessary!

re: 99215

The criteria is in the front of the CPT® book. As long as he meets 2 of 3 of the required components, he can charge that 99215. If medical decision making isn't meeting the HIGH complexity, make sure his HISTORY and EXAM are! You should be ok with that.