PRODUCTIVE PROVIDER NEWSLETTER
Vol. 2, Number 1, January 2004
Published by: Jim Meeks,P.A.-C.
Medical Professional Education
and Consultation Services
© MPECS 2004
Understanding TodayÕs Healthcare,
Serving TodayÕs Patients,
Meeting the needs of TodayÕs Practice.
Welcome to our expanding group of E-Zine subscribers who have signed up through www.mpecs.org
It is my pleasure to again bring to you this free E-Zine called the Productive Provider Newsletter. Dedicated to bringing you thoughtful information on the confusing topic of Evaluation and Management (E&M) coding.
Please feel free to respond, comment and suggest on the content of this newsletter. For more information about me and on what I am doing, please visit me at www.mpecs.org. Also, feel free to forward this E-Zine to anyone you feel may be interested in learning more about E&M coding.
Thanks, enjoy this newsletter and have an absolutely wonderful day.
AT A GLANCE: In todayÕs newsletter
1. ItÕs Just MY Opinion
A new focus for MPECS,
2. There is money on the table, is it yours?
Have you ever lost a $20 bill? You know you had it in your pocket, but it is now gone. DoesnÕt that just drive you crazy? Some practices walk away from money all day long.
3. Six steps
Six steps you can take to improve your coding and documentation efforts.
1. Its Just MY Opinion
For several years now, I have been focusing on the topic of Documentation and Coding From the ProviderÕs Perspective. This was the original name of my lecture at the University of Utah PA Program when I began teaching this subject to PA students back in the last century (1995).
With the beginning of the 2004, I thought it was time to change the outward focus of MPECS. The title Documentation and Coding From the ProviderÕs Perspective doesnÕt fully describe what I do at MPECS. It really is only a partial picture of the total objective, so to speak.
While I do teach physicians, physician assistants and nurse practitioners, billing clerks and office managers how to appropriately code for office visits and other patient encounter services, ultimately, I assist medical practices in bringing back profitability to the business end of the practice.
We all know what a challenge it is to make sense of the 1995 and 1997 documentation guidelines. The system if very complicated and really makes it difficult to always be sure which code to select. As a practicing healthcare provider, I believe I bring a unique perspective to this topic.
However, what I have found is that trying to describe what it is I am teaching and trying to accomplish with MPECS can be almost as confusing as the name of the workshop. I have decided to eliminate the confusion and go for a direct approach. Although the core content of what I teach has changed very little, the presentation and workshop are constantly being evaluated and upgraded to maximize the value of the workshops to those that attend.
To correctly reflect an overall view of what we achieve in an MPECS workshop, the new focus will be:
PRACTICE PROFITABILITY Š Strengthening Your Bottom Line
ŅYour Bottom LineÓ refers to you as a provider, your practice as a place of healthcare for your patients and to your business, the life of which sometimes can be on the brink of a full arrest if neglected. All three of these areas are interdependent with each other. If one area is neglected, the others suffer or even fail.
My goal is to be sure that every provider and practice is as successful as they can be. MPECS is the tool to make that happen. If you arenÕt sure about how well you are doing or not doing, you should consider attending a PRACTICE PROFITABILITY workshop.
Let me know what you think.
Jim Meeks, PA-C
Unless you have immediate access to a current CPT book, you risk potential down coding in your daily practice. How often do you struggle with the choice between which levels of service to bill for? Is it a 99213 or is it a 99214? Do you know the specific elements of exam that determine which level to choose? Are you confident in your selection? WouldnÕt it be great to have a quick reference that you could easily refer to in the exam room, the hospital, care center or where ever you are seeing patients?
The POCKET CODER© is the answer! It is perfect for your daily practice. It will solve your E&M code questions and eliminate down coding from your practice. Order yours today on line at www.mpecs.org.
2. There is money on the table, is it yours?
Can I ask you to play along with me for a minute?
Please consider the following. Just imagine that you own a business where you provide some specific service to your customers. Would you consider billing several customers a day at say 30% less than the amount you typically charge for your service, even if the client were willing to pay full price for it?
How long do you think you might be able to stay in business if you did that very often? What if you had neglected to include several items on your invoice to the customer when you billed them? If you didnÕt bill appropriately for your services, would you be able to continue on that way for very long?
A similar situation occurs in medical practices all across the country. Every day, you see patients and provide services to them for their healthcare. Somewhere during or after the patient encounter, you somehow have to provide the practice billing staff with something that gives them an idea of how to bill the patient.
Many practices use a form called a superbill or a fee ticket. This may be a pre-printed form or something that is generated by the practice billing software at the time of patient check in. Often the provider, having seen a patient, simply checks off a few boxes to indicate the services provided and sends it off to the billing clerk.
Here is my concern. When you select a code to charge for the office visit, how are you deciding which level or code to pick?
If you see a new patient, you must pick from five distinct CPT codes, 99201 through 99205. If you have seen an established patient, you pick from codes 99211 through 99215. If you are doing an office consult, the codes are 99241 through 99235. If you are doing inpatient consults, admits, and a number of other possible patient encounters, there are specific codes for each of these types of encounter.
Each of these codes requires documentation of specific elements in the areas of history, physical exam and medical decision making. Your level of documentation will determine which level of care has been provided and which code is used for billing.
In my family practice, a 99213 is billed at $62. A 99214 level encounter is billed at $98, which is $36 or about 58% higher than the 99213 level encounter.
What I have discovered in my many discussions with many physicians, physician assistants, nurse practitioners and office managers is that many times providers are marking their superbills at the 99213 level when they are in fact doing 99214 work. When this happens, they are essentially walking away from what they are entitled to, leaving $36 bucks on the table.
There seems to be hesitancy by some providers to use the 99214 code. We have all heard statements from federal agencies indicating that the 99214 area of billing is the area that they are currently focusing on in fraud investigations. Great! Another reason to always bill an office visit at 99213. Gee, if I bill a 99215, will I automatically be sentenced to federal prison?
In reality, there should be no fear in using a 99214 code if you have provided the level of care that is required. The key is to be sure that you have documented the encounter sufficiently to stand up to an audit. Let me share one example for your consideration. This is by no means all-inclusive, but hopefully will illustrate my point.
Ask yourself these four simple questions to determine if your encounter documentation qualifies for a 99214 billing. (Remember, this is for established patients. New patients have different criteria)
Does the history of present illness identify four or more elements? (8 are recognized/possible)
Does the review of systems cover from two to nine organ systems?
Did you document one item of past medical, family or social history, or did you review and update a
medical history sheet? (It must be dated and documented in the record)
Does the physical exam cover at least 12 bullets of the multi-system exam criteria?
If you answer yes to these questions, your encounter qualifies for a 99214 billing. This is only one example from a number of possibilities, but I hope you get the idea. If you are unfamiliar with or unsure of any of the items mentioned in the questions above, you need to learn more about evaluation and management coding.
I have found that most providers are totally surprised to discover that a fair number of their daily in-office patient encounters meet this criteria and that they have been under coding them. There are other elements and variables such as medical decision making to consider, and I donÕt have the time or space to go into every aspect of code selection here today. My point is to point out to you that unless you are familiar with the elements of evaluation and management coding, you may be short changing yourself and your practice when it comes to billing.
There is no reason to under code a patient encounter. However, because of fear, lack of time, training or whatever, it happens all the time. It is bad enough that insurance carriers and government programs discount provider payments in the first place, is there any reason that you and I should not appropriately bill for the service we have provided? This applies to all levels, 99211, 99212, 99213 and so on, in every patient encounter setting.
In every encounter, the potential is there for under coding the visit. DonÕt make that mistake. It is expensive and inappropriate.
We all appreciate an itemized bill or statement from someone that we hire to do a job for us at home or on our cars. Think of your medical record as the itemized statement and the superbill as the invoice. The medical record should support the level of billing you submit. If not, that is where fraud becomes a legitimate concern.
Be fair, be honest, be ethical, but by all means be detailed and deliberate in your documentation and billing.
PRACTICE PROFITABILITY WORKSHOPS:
MPECS is dedicated to making your practice of medicine more productive, more profitable and ultimately more enjoyable. I have developed a comprehensive 4-hour PRACTICE PROFITABILITY workshop that focuses on the specifics of documentation and coding. If you ever find yourself questioning which E&M code you should use, you need this workshop!
The next MPECS workshop is scheduled in Salt Lake City on April 24, 2004. The website has the current details. Mark your calendars and register early! Please visit www.mpecs.org for more information.
Other conferences where I will be speaking:
„ California Association for Nurse Practitioners Conference, March 25, 2004, Monterey, California
„ Society of Urologic Nurses and Associates Conference, October 25, 2004, Orlando, Florida
3: Six steps you can take to improve your coding and documentation efforts.
A couple of years ago, there was an excellent article in Medical Economics entitled The Biggest Coding Blunders and How to Avoid Them. I would recommend this article to anyone involved in coding and documentation. You can access it in the past issues section of Medical Economics at www.memag.com. Locate the August 21, 2000 issue and find the article in the index.
Below, I have paraphrased and revised for my own use six steps presented in that article. They are important to your success.
Make sure you understand how to use the CPT and ICD-9 books Š are your copies current for 2004?
Take advantage of outside workshops, resources and experts to increase your coding skills
Be sure that the coding and billing personnel in your practice are properly trained and supervised
Make sure your office forms work for your practice, revise them until they work correctly
Do regular audits of charts of every provider in the practice
Make sure your billing software is up-to-date
WORKSHOPS: Do the E&M codes you are currently using actually reflect the level of care you provide? Attend an MPECS workshop where we focus on issues of documentation, physical exam criteria, medical decision making, chart auditing and other issues that are essential to maximizing your personal and practice success.
I will gladly bring a workshop to your community. Please contact me via my website for more details. Also, please visit the website often to check and see when and where workshops are being scheduled. Happy coding!
Our comprehensive 4-hour PRACTICE PROFITABILITY workshops have been very successful. The comments and evaluations from participants are all very positive. Those in attendance have overwhelmingly appreciated the information presented.
If your local, state or national association is looking for CME activities, topics, lectures, workshops, I can help. Forward this E-Zine newsletter to your State CME chair. Contact me via www.mpecs.org.
TELL SOMEONE ABOUT US
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Jim Meeks, P.A.-C.
Medical Professional Education
and Consultation Services
P.O. Box 899
Pleasant Grove, UT 84062-0899