Member Forum

1.  99215 and Medicare

Posted 2 days ago
In past 12-18 months I have had 3 requests for my records because of using 99215.   I suspect my use of 99214 and 99215 is making me an outlier.  My patients are scheduled every 30 miutes.  They tend to last approximately 40 minutes.    I dont  need to tell this group the complex nature of seniors problems and the savings to the system, etc.

The "get out of jail free" card seems to be using a modifier "GA" and having an "ABN" on file.
My question to group is how are others addressing this?   I realize that time is not the sole determination of a visit code but it is a very objective reality.)

Are you just managing the clock and informing patient(s that their problems are complex and we need to schedule more time - We know this is not easy for many of our patients who rely on rides, etc.
Are you having patients sign an ABN each visit?    Are you pausing visit at 25 minutes and asking patients to sign an ABN or schedule another visit? (Awkward).

I have a few patients who have made it clear they do not want to be responsible so it is "easier" to end the visit at 25 minutes.

I look forward to others suggestions.  Please dont just say that we should not accept medicare.   I understand and respect  that philosophy.  However, I like my patients and the relationships and dont want to change dramatically at this stage of my career.


Michael S. MD

2.  RE: 99215 and Medicare

Posted 2 days ago
3 requests in how long? 
I personally don't use the 99215 very frequently. When I do use it I make sure the clinical documentation and the time is documented also. My new patient visit is 60min. Subsequent visit 30min. Most of the time I bill 99214 for Chronic care visit. I don't have patients sign ABN. I would just continue to  make sure that the documentation is consistent with the 99215. I end up seeing my medicare patients 4-5 times / year sometimes that includes AWV. Greetings to everyone! 

Edgar Cruz
Cruz Medical Services
Clermont FL

3.  RE: 99215 and Medicare

Posted 2 days ago

 I went and looked up GA modifer and got upset
I would not use an abn  for a 9915
that is for things like cosmetic stuff that is not or unlikely to be covered Otherwise i submit my 99215 and document the hell out of it I have a macro that prints out "50% of the visit time was counseling or care coordination"
 I find 3 or 4 dx     I think you cannot use the 50%   based on time rule with  new visits
I admit I worry about 99215s so prob sometimes I undercode

Being an iMP I have long heard that upstate mid NY state medicare carreir  will not pay for some things Myria Emeny used to say this She was outside of Albany
 Appeal? Call  your sneotr or the CMS regional office?
  The story of Earl Carstenson in CO is well docuemtned about 12 yrs ago on the AAFP  list serv He was tortured by UNited  which was  way over 50% of his panel, for  using too many 99214s    he  would see people for 1 thing an d have them leave becasue he was  so tortured by United  He took them to task and got AAFP on his side but he suffered alot

     Jean Antonucci MD
     115 Mt Blue Circle
     Farmington ME 04938
ph 207 778 3313   fax 207 778 3544

4.  RE: 99215 and Medicare

Posted an hour ago
Thanks Jean and Edgar.

Curiously, on the three visits I was reviewed, I did not use the GA modifier.   

I think I will be more diligent about having the ABN signed and continue using the GA modifier.   My reading and understanding of GA and ABN seem to support how I use them.

On the first two claims I submitted records for over the past 2 years or so, I have not had my coding overturned or down coded.   I just submitted records for the third visit.