[Ohioaap-practicemanagers] Aetna downcoding

[Michael Chamberlin]

I have heard from a few  local (Cincinnati) practices that Aetna has been
automatically downcoding some 99214-15s to 99213s over the past several
months.    They received a letter in the spring of this year that said
basically that their 99214-15s were higher than their peers, so Aetna was
going to correct that.  They are paying for a 99213 at times when a -14 or
15  (appears to be based on the dx code) is billed and have not been asking
to review records to evaluate the code that was billed.

I have  asked them to submit this info to the AAP Hassle Form.  One
practice said that they submitted one Hassle Form, but that nothing came of
it.

Have other practices received letters like this or experiencing automatic
downcoding of office visit codes?  I know that there have been other
insurance companies called out of SOAPM for this, but I have not seen
anything about Aetna.

Thanks,

Mike

-- 
Michael Chamberlin, M.D., FAAP
Pediatric Assoc. of Mt Carmel
4371 Ferguson Dr
Cincinnati, OH  45230
513-752-3650
513-752-3387 (fax)
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