Coding: Your Top Coding Problems Solved

October 1, 2007

Tips from our biweekly e-mail newsletter. This issue: Break your EMR’s bad habits.


We all know that EMRs are designed to make a practice’s operations more efficient, accurate, and secure. There are a host of good reasons to adopt EMRs, but some traditional drawbacks seem to tag along as well.

Take the documentation for a patient’s history of present illness (HPI). In paper charts, we have long seen abbreviations for “here for follow-up,” “here for refills,” and “here for labs.” We know that’s not really the reason for the patient’s visit. The patient is there to have his problems actually evaluated and managed by the labs and medications you prescribe - and your note should always state this.

Now we are seeing the same conventions embedded within EMR software, although they may be dressed up a bit to appear more robust: “Patient present for evaluation and management of chronic medical problems.” Perhaps some programs automatically display the patient’s problem list and/or medication list.

But that’s not an HPI either; it’s just a list. What if the record actually prompted the provider - or even hard-halted the note - to detail some relevant information about the status of the patient’s chronic condition? Wouldn’t it be cool if the chart then provided a space, or even some suggestions, for you to conduct a relevant review of systems to accompany the HPI particulars?

I realize we may be talking artificial intelligence here, but let’s use the electronic format to train physicians to supply the real data payers require, not just make an electronic version of the old, inefficient paper chart system.

Instead, allow the system to shape the encounter, and electronically integrate the elements needed for successful coding, documentation, and billing.

Billing for complementary medicine

The CPT manual contains many codes for services considered to be “complementary” or “alternative” therapies. Chiropractic, OMT, acupuncture, and massage are all represented in the manual, and in many insurance plans they are recognized as covered services. But the healthcare community at large offers many more modalities and services that are not represented in the CPT, including Healing Touch, Reiki, Ayurvedic medicine, and body work such as yoga.

A distinct gulf separates the types of services desired by patients and those covered by insurance. Providers of treatments on the less-recognized menu of complementary healing arts often resign themselves to being “cash-only” businesses.

But what really happens when the worlds of insurance and complementary services collide? In my work as an author and auditor, I have seen physicians offer “energy” work - guided meditation and affirmations - and then bill an E&M code for the service. If they code by time, they say that over half the visit was spent “counseling.” Well, not exactly. Providers of whatever ilk need to be very careful to identify the true nature of the services they provide. We may not like the implications of coverage limitations regarding complementary medicine, but that doesn’t mean we can just finagle the codes to receive reimbursement.

Another approach is to allow physicians in your practice who provide both traditional and complementary medicine to wear more than one hat: Maintain an established, mainstream, insurance-based practice in one setting, and set up another complementary or alternative medicine practice in another.

Don’t allow your desire to provide lower-cost natural healing modalities lead you down the road of fraud and abuse. Call your services what they are, and let the reimbursement chips fall where they may. The system will ultimately equalize itself based on what patients want.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for over 18 years. He can be reached at billdacey@msn.com or via info@physicianspractice.com.

This article originally appeared in the October 2007 issue of Physicians Practice.