Thanks Linda. The provider did not tell me that they are coding all sick visits as 99214, I made this analysis myself by looking at past claims. In 2011, my children had a total of 7 sick visits. Six were coded 99213 and one was 99214. In 2012, my children have had 11 sick visits so far. Nine have been coded 99214, one was 99213 and one was 99215. The 99215 is what really caught my attention and got me looking into this. When I asked the provider about it, they did an audit and said the 99215 was an error and should be 99214. They also said one of the 99214's should have been 99213. When I asked why the coding had changed from mostly 99213 in 2011 to mostly 99214 in 2012, they told me that five of the 99213 visits in 2011 had been under-coded.
I tried to get some help from my carrier (Anthem) on this and they have been less than helpful. They are only interested in looking at one claim at a time, not the overall situation. So I picked one of the 99214 visits that seemed especially simple and asked them to review it. It took a total of three months for Anthem to get the records into their system and sent to the review department. I faxed them twice and then finally mailed them. I know the provider faxed them a couple times as well. Anyway, Anthem came back and said that the provider had met the criteria for billing 99214. They said they do not challenge the provider as long as the records support the billing code. They said if I disagree with the level of service provided, that is my issue to take up with the provider. From what I have read online, the provider can pretty easily give a detailed exam and get a detailed history and bill that as 99214, even if there is no medical decision making (since only 2 of the 3 criteria are needed). I think that is what may be happening here. Not sure what to do next since we really do like the doctor himself.