Forum - Questions & Answers

Mar 17th, 2015 - dburd 1 

99214 Frequency

We have a patient who has Medicare and is insisting on being seen nearly every other day. Is there a cap on the frequency that a 99214 can be billed in a year for Medicare ? We do not want to flag Medicare for an audit, nor bill in error. I am not sure how to bill this since the patient has a valid complaint each time he comes in to the office to be seen. Can anyone advise?
Thank you

Mar 17th, 2015 -

re: 99214 Frequency

I guess my question is that if the patient insisits on being seen nearly every other day is he have presenting problem that is moderate to high severity. He may have a valid complaint but is it meeting the guidelines of a detailed history, a detailed exam and the mdm also of moderate complexity?? Which means in terms that he should be having a number of extensive diagnoses, the amunt of data to be reviewed would also be extensive(how are you acheiving that if he is being seen every other day) and the risk of complications and or morbidity/morality is high (how are you meeting all these elements since you just would of reviewed them in a previous encounter just 24 to 48 hrs ago)

To complete the exam you need to have a complete singel system exam, or complete multi system exam(9 body areas or organs system). Maybe you should reevaluate if you are following the guidelines for this level of E&M

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