UHC downgrading ED facility coding level 4 and 5 99284/99285
As some of you may have experienced, UHC has implemented their policy on ED visit coding. You can read the policy on page 12 at this link: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/News/December-Interactive-Network-Bulletin-2017.pdf
It is interesting because there are no official guidelines for code selection; each facility should have their own code selection guidelines so UHC is "forcing" their own proprietary coding guidelines on hospitals.
Furthermore, PEPPER has started to report 99285 usage.
On a recent NAHRI call, it was suggested that every facility review their coding guidelines for facility ER visits, first to be sure they exist and then to be sure they are sensible. Then check your payer contract to see if it allows or forbids UHC from downcoding automatically. Also look at your PEPPER data to see how you compare for Medicare patients.
Have any hospitals had any ED visit coding downgraded by UHC? Did you think it was appropriate? Will you appeal?
It is interesting because there are no official guidelines for code selection; each facility should have their own code selection guidelines so UHC is "forcing" their own proprietary coding guidelines on hospitals.
Furthermore, PEPPER has started to report 99285 usage.
On a recent NAHRI call, it was suggested that every facility review their coding guidelines for facility ER visits, first to be sure they exist and then to be sure they are sensible. Then check your payer contract to see if it allows or forbids UHC from downcoding automatically. Also look at your PEPPER data to see how you compare for Medicare patients.
Have any hospitals had any ED visit coding downgraded by UHC? Did you think it was appropriate? Will you appeal?
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