12/19/2022

E/M Claims Down Coded-Fidelis

Fidelis Care originally approved payment for correct level of service - 99214. Documented on EOB. On same EOB Fidelis down coded the service to 99213. Payment made for lower level of service. Reason code: N22 - Alert, This procedure code was added/changed because it more accurately describes the services rendered. The decision was made by a computer program developed by COTIVITY. ( A company than Fidelis hired to evaluate claims.) This was NOT a Pre-Payment or Post Payment review. No medical records were reviewed.

It is advised that these should be appealed. All necessary documentation should be supporting level 4 of course. Please note that if you are billing via "time" rather than MDM, be sure to separate time performing procedures from E/M time as it would cause overlap.