Coding & Documentation

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E & M Coding Benchmarks

Compare your E&M coding patterns with national norms from Medicare. It's a fast way to see if you are out of whack. Translate Medicare's data for your specialty into percentiles for easier comparison.

QDC codes themselves carry no payment for a claim. However, using the codes correctly may result in a bonus payment from Medicare, and not reporting them successfully will result in a penalty.

With so much else changing in healthcare, it's understandable that you'd want to avoid thinking about transitioning to the coming ICD-10 code set. But the longer you wait to start, the tougher it will be to make the switch, and the more likely you are to lose money. Here's what you need to know to avoid claims denials and ensure a smooth conversion.

Level 5 Cases

This pediatric cardiologist thinks that all his patient visits should be coded as level 5s. Is he right?

I have a physician who saw a patient for a preventive visit and also charged a 99215 for this patient on the same date of service. He used the same documentation for both visits. Should he have documented each service separately?

Level 5 codes based on "breadth of management" need to clearly explain "why" the reported illnesses pose significant risk to patients. Should the physician add a statement to to her assessment that explains why the combination of multiple chronic illnesses pose a risk to the patient's morbidity/mortality?

A discussion arose between the auditors in my office regarding "double dipping" and I am wondering if you would mind clarifying something for us. One auditor says that it is permissible to obtain a review of systems (ROS) from the CC of "arm pain" - using arm as the location in the HPI and pain as the ROS under MS. I have never audited in this manner and would appreciate any advice or direction you can offer.

EKG Inquiry

When counting points for the data reviewed in E&M, do you count "independent review of image, tracing, or specimen" (two points), for example, when a cardiologist sees a patient, interprets an EKG, and provides an E&M service?

I know that there are going to be significantly more codes with ICD-10, but will the rules change regarding how codes are assigned?