In a proactive move, the Academy recently alerted health plans across the nation to a new coding reality: Expect an increase in the number of high-level evaluation and management codes (e.g., 99214, 99215) billed by family physicians.
"The AAFP encourages family physicians to work in collaboration with payers to assure a common understanding of the use of higher level E/M CPT codes in a changing practice environment," said AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., in an April 7 letter. "It is our hope that all private payers recognize the shift in the intensity of E/M services."
In the letter to payers, including Aetna, CIGNA, UnitedHealthcare, WellPoint and more than 40 national and regional Blue Cross and Blue Shield health plans, the Academy spelled out some of the reasons behind the shift in coding levels.
The overall aging of the general population coupled with an accompanying increase in chronic health conditions that are treated in the ambulatory care setting rather than in the hospital "result in patients needing more complex care than they did a generation ago," said Frank.
Other factors driving the uptick include
Insurers Can Expect Uptick in High-Level E/M Codes
By News Staff
4/12/2006
- implementation of electronic health records that more accurately capture visit data;
- adoption of office systems, such as patient registries, that allow physicians to enhance their preventive and chronic care efforts during office visits;
- implementation of planned care models that help physicians manage increasingly complex chronic diseases in office visits; and
- increased use of alternative methods of physician/patient communication resulting in less frequent but more intense office visits.
Family medicine involves the concurrent care of multiple problems, but family physicians have historically undercoded office visits, Frank told insurers in the letter. In addition, "public and private insurer fraud and abuse programs, and physician profiling/outlier programs have produced defensive coding patterns," she said.
In an effort to ensure that physicians are paid for the appropriate level of care provided, the Academy provides education to members regarding accurate coding and documentation techniques, said Frank.
"It is important to the AAFP that all insurers pay physicians for the appropriate level of care that is delivered, documented and coded," she added.
In an effort to ensure that physicians are paid for the appropriate level of care provided, the Academy provides education to members regarding accurate coding and documentation techniques, said Frank.
"It is important to the AAFP that all insurers pay physicians for the appropriate level of care that is delivered, documented and coded," she added.
