My take on coding is quite different from most instruction I have received in the past. I was taught: see the patient, write your note, and then look at your note to determine the level of service. This method leads to poor notes, poor compliance, poor reimbursement, and an unorganized approach to coding and compliance.

I teach the following: While you are seeing the patient, determine what possible level(s) of service the visit will be. Then write your note to reflect the appropriate level of service. This will ensure that compliance is foremost on the mind of the practitioner. It also tends to eliminate both under-coding and over-coding problems.

For example: I walk in the room and the patient is there for follow-up of a chronic problem (asthma, hypertension, etc.). By the end of the second hour of the seminar, you will realize the following things:

• If you simply refill one medication, you would bill a 99213.
• If you refill multiple medications, you would bill a 99214.
• If they have a mild exacerbation, code 99214.
• If you make a medication change, code 99214.
• If they have a severe exacerbation, code 99215.