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How Proper Use of 99231 For Medical Billing Claims Can Boost Your Earnings

How Proper Use of 99231 For Medical Billing Claims Can Boost Your Earnings

How Proper Use of 99231 For Medical Billing Claims Can Boost Your Earnings

Unsure of the correct medical billing procedures, physicians frequently downcode 99231 for quick payment. There are so many rules and regulations associated with medical billing, physicians tend to downcode whenever there is a questionable decision. A frequent downcode is 99231. Properly billing 99231 can save practices thousands of dollars.

There are three codes that are often misused: 99231, 99232, and 99233. 99231 means problem-focused interval history and exam, straightforward or low-complexity medical decision making. 99232 means expanded problem-focused interval history and exam, moderate-complexity medical decision making. 99233 means detailed interval history and exam, high-complexity medical decision making. The three components to look for when deciding on a code for medical billing are history, exam, and the medical decision making. Two of the criteria must be met in order to use a particular CPT code.

Very often, when physicians report a 99231 for medical billing, the visit was actually a 99232 or a 99233. This results in much lower revenue for the practice. If a medical billing company submits a claim for 99231, but it should be 99232, this means they are getting reimbursed $20 less then they should be. This means, if your practice incorrectly medically bills 99231 12 times a month, it would cost you $2880 a year.

If you suspect your physician has been consistently downcoding these visits, do an internal audit on a random few. Make sure when performing medical billing on the codes in the future, they represent the correct history, exam and medical decision making levels. It may take a bit of time to check the past work over, but it will save you money in the long run.

There are many CPT codes that are misused when performing medical billing. Since 99231 is one of the most common codes, make sure to keep a look-out for any misuses. By using correct medical billing codes your practice will save tons of money.

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