Barbie Hays, CPC, CPMA, coding and compliance strategist at the American Academy of Family Physicians, has simple advice on coding education: "Know your practice."
This means physicians should know the services they deliver and the associated billing codes that represent those services. While this may sound like an "overarching and lofty" goal, she argues that coding accurately is "essential to practice health."
In her work with physician practices, Hays has witnessed a tendency by many physicians to code lower than the level of care they're providing. There are a number of times she's audited physicians only to discover they're using CPT code 99211 when coding patient visits.
"Technically, a 99211 is considered in the coding world and in the physician world as a 'nursing visit.' A physician doesn't even have to be present in the room [to code a 99211]," she points out.
Many physicians worry about their patients’ ability to pay for visits, so they under-code for emotional reasons, or they “want to be nice.” The other reason is ignorance, she laments.
Hays is referring to the belief by many physicians that if they don't code many “4” and “5” codes that get audited, then they are safe. The problem is, many physicians believe, incorrectly, that if they code 1s, 2s, and 3s that they won't be audited, she says.
Patients will be charged their copay and physicians could actually attract attention by consistently under-coding, which would put them below the bell curve with their colleagues across the country.
That’s why Hays recommends doctors code for the services they’re providing. “Code what you’re doing. Get paid for being a doctor,” she advises doctors. There are two reasons physicians need to code appropriately: Physicians need to stay in business and they also need to manage their own well-being.
"If you're not making money, if you're not able to pay your staff; if you're not able to pay yourself, then you're running into physician burnout issues, such as depression. It just spirals," she says.
Focus on Common Codes
Physicians need to focus on common ICD-10 and CPT codes. If 80 percent of a physician's practice is delivering E&M Services and Preventive Care Services, "they really need to know those codes inside and out." Experts also say physicians need to fully understand the documentation that's required to support those codes.
While there are 68,000 codes in the ICD-10 code set, the important difference between it and ICD-9 is the degree of specificity required in doctors' documentation, says David Wasserman, an advisor with the practice solutions and medical economics group at the Massachusetts Medical Society, where he consults with physician practices. For example, documenting a patient who is experiencing foot pain is no longer enough; physicians need to document their patient's specific foot ailment.