Academy of Chiropractic

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From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

Correct Coding for Re-Evaluations

 

 

“Money is Not Bad” Mark Studin 2020
 
Pay careful attention to the 2 Evaluation & Management coding charts below. The details, which have been constant since 1997, will survive the new requirements coming January 1, 2021. Those changes will be detailed in a subsequent consultation. Today we are focusing on accurate coding of your re-evaluations. Too many DC's have been improperly downcoding due to a lack of understanding of the codes, and losing money for work done and subsequently not coded/billed.


If you look at the chart above, the 99203 is labelled Evaluation/Management - Detailed. The face to face time is typically 30 minutes. When you carefully look at the Established patient (or re-evaluation) chart, a 99213 is labelled Evaluation/Management - Limited. This code's face to face time is typically 15 minutes. 

​​​​​Before January 1, 2021, the time was only a component that did not have to be met, there were "bullets" or evaluatory items that had to be met. After January 1, 2021, time is an essential factor. 

The same level of coding for an initial level of 99203 has the equivalent level for a re-evaluation as a 99204. It has the same designation of a Detailed report, and the time requirement is typically 25 minutes, which is less than a 99203. The RVU's (relative value units) are also similar:

99203 = 3.03
99214 = 3.06

The next issue, is who is spending all the time with the patient, the doctor, staff, or a combination of both. A future consultation will handle that. 

Lastly, you MUST take both parts of Primary Spine Care 10, as we go over this and other critical practice details that you must have in place by January 1, 2021. If you have not already taken the course, click below RIGHT NOW!
 

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