PRODUCTIVE PROVIDER
NEWSLETTER
Vol. 2,
Number 1, January 2004
Published
by: Jim Meeks,P.A.-C.
M.P.E.C.S.
Medical Professional
Education
and Consultation Services
PracticeProfitability@mpecs.org
© MPECS
2004
~~~~~~~~~~~~~~~~~~~~
Understanding
TodayÕs Healthcare,
Serving
TodayÕs Patients,
Meeting
the needs of TodayÕs Practice.
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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
ADVERTISEMENT:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
ADVERTISEMENT:
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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
If you like what you see, please recommend and forward this
E-Zine to anyone that is interested in using Evaluation and Management codes more effectively, and in
becoming more productive in his or her medical practice.
If you are receiving this as a forwarded message, and you
want your own subscription, visit our website and sign up on the ŅSite Mailing List.Ó
Jim
Meeks, P.A.-C.
M.P.E.C.S.
Medical Professional
Education
and Consultation Services
P.O. Box 899
Pleasant Grove, UT 84062-0899
Voicemail: 801-915-4447
PracticeProfitability@mpecs.org