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11 Common Coding Questions (and Their Answers)

11 Common Coding Questions (and Their Answers)

  • ©StuartMiles/Shutterstock.com
    ©StuartMiles/Shutterstock.com

Inaccurate billing and coding can create a ripple effect through a practice. Not only can coding errors lead to an uptick in denials and delayed or lost revenues, it can also heighten tensions with patients upset by a prolonged and error-laden billing process. Plus with payers frequently updating specific coding guidelines, it can be difficult for staff to stay ahead of the curve and may often leave them frustrated as well.

To get your billing back on track, experts shared common coding questions and their answers.

Click here to download a PDF of this slideshow.

Steph Weber is a freelance writer hailing from the Midwest. She writes about healthcare and small business, but finds her passion for the medical field growing in sync with the ever-changing healthcare laws.

Source: 
Physicians Practice

Comments

I definitely concur with Joette about the 99215 level visit being absolutely billable on the basis of time, exactly as she outlines.
I also disagree with your slide explaining the "difference between 99213 and 99214" that says:
"Patients who present with conditions/illnesses that are uncomplicated in nature and will usually follow a predicted resolution path are typically reported with 99213. Patients who present with more complex conditions/illnesses that may require additional follow-up or medical management are typically reported with 99214." Angie Babb, CPC.
This incorrect reasoning, commonly shared among primary care providers, explains why so many primary care visits for existing patients are undercoded as level 3 when the actual visit (documented appropriately) lends itself to level 4. Even if the condition is commonly seen, easily treated, and has a "predicted resolution path," for example, suspected community acquired pneumonia or suspected acute prostatitis, the medical decision making (MDM) is automatically "moderate" (3 problem points as a "new problem, no further w/u planned" or 4 problem points if you order additional w/u such as chest xray or urine culture, both which make risk level "moderate"). With 2 of 3 components met for MDM level 4, all you need to do is ensure that your HPI documents 4 attributes (onset, location, radiation, and alleviating factors, e.g.), 2 ROS (hard not to meet), and 1 PFSH (also hard not to meet). At this point, the physical can be very brief while the visit still qualifies for 99214, following the 2 of 3 rule for existing patients (Hx, PE, MDM). Remember, just because it's commonly seen, easy to treat, and typically resolves, does NOT mean it's without risk, and RISK (different than expected clinical course) is the deciding factor between level 3 and 4 visits. In general, if your existing patient has a new condition and you've ordered any test and prescribed any medication, documented correctly it will qualify for a level 4 visit.
Anne Walsh, MMSc, PA-C, DFAAPA

Anne @

I disagree with the following slide in this presentation: I spent more than 40 minutes with a patient, can I use the 99215 level code?
"The 99215 code [allows] for 40 minutes spent face-to-face with the patient and or family. However, the code is not time-based. In order to use this code, the visit must meet two of three components. It should include a comprehensive history of the patient, a comprehensive examination, or medical decision-making of a high complexity. If these requirements are met, even if the visit is less than 40 minutes, the code can be assigned." Tatyana Kantor, CPC

Both the 1995 and 1997 guidelines allow for time to be the controlling factor. Here is Novitas' E/M score card: https://www.novitas-solutions.com/webcenter/content/conn/UCM_Repository/... If the physician documents total time and suggests that counseling or coordinating care dominates (more than 50%) the encounter, time may determine level of service. Documentation may refer to: prognosis, differential diagnosis, risks, benefits of treatment, instructions, compliance, risk reduction or discussion with another health care provider.
Does documentation reveal total time?
Does documentation describe the content of counseling or coordinating care?
Does documentation reveal that more than half of the time was counseling or coordinating care?

If all answers are "yes", select level based on time.

The 95 and 97 guidelines do not require any more than the above documentation.

Joette Derricks, FACMPE, CHC, CPC, CLSSGB
JPDerricks@gmail.com

Joette @

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