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Hope you’ve all enjoyed a pleasant summer. We’ve been working here on a new conference called Advanced Coding Strategies and have an example I’d like to share with you:
Patient comes in with mild/minimal abdominal pain. Very negative review of systems. Pretty negative history. Negative physical exam. You obtain simple labs and abdominal films. You give patient instructions (simple dietary changes, drink more water, if symptoms worsen return to clinic as needed). The radiologist calls you later that day and says they look constipated, so you call and have them take some over-the-counter laxative.
Let’s look at medical decision making: Your level of risk is low (acute uncomplicated problem). You have at least moderate level of diagnosis/treatment options (otc drugs, education, conservative measures). Normally we would think about this as a relatively straightforward level 3 patient. Because normally we don’t really consider Data Review.
In this case we have to consider Data Review: We get 1 point for ordering labs, 1 point for ordering radiology, but we also get 1 point for ‘discussion of unexpected test results with another physician who did the test’ (i.e., the radiologist). That puts our medical decision making at Moderate (3 treatment options and 3 points of data review). If we have enough History and Physical (and we should) then this becomes a 99214.;
The moral of this story is that the level of service is usually driven by the level of Risk in medical decision making. But not always. You must take all of the coding information into account when deciding what level of service you just performed.
We are finalizing plans for our first-ever Advanced Coding Strategies course. We should have final information next week, but it looks like it’ll be held in the Dallas area on Saturday morning on October 15th. It’ll be a 4 hour course and will go into further detail about the different coding challenges that we all face in primary care. As part of this course, attendees will have the chance to submit their personal ‘coding challenges’ prior to the event so they can be discussed by the forum. We will explore the many issues that have come up with coding problems and questions once the Coding Growth Strategies course has been completed. The course will be recorded and available shortly after for those unable to attend.
We are trying to gauge how large of a venue will be needed. If you are interested in more information about this course, please submit this form. Send me more information about Advanced Coding Strategies or call David at 866-335-2040 (toll-free).
I’m very excited about another service we will soon be offering. We have had hundreds of people inquire about how to obtain a ‘friendly audit’ for their practice. Most of these audits tend to run $500-$1000 or more for such a service. We are in the process of making these auditing services available at a much more reasonable price. We are contracting with a group of certified professional coders. You would submit charts and receive detailed reports and letters explaining not only what the note should be coded as, but also any particular issues or pitfalls associated with it. If you’ve attended our seminars in the past, you know what this is like. “This was coded as a 99213 and that is correct. However, your level of Risk was high enough that if you put one more patient instruction like ‘return to clinic in 3 months’ you would’ve had a 99214.” Our goal is not just to audit the chart, but to instruct and teach how to make sure your documentation, nature of the presenting problem, and final coding all match every time.
I’m about to start using this in my practice by having a ‘snapshot’ taken of 25 charts per provider every 3 months. This way I can identify trends and problems and see what coding issues I have (or my other providers are having). This gives me a sort of ‘barometer’ for my practices coding and financial health.
I will give you more information over the next few weeks about this exciting new service.