Hey everyone! We just finished editing and duplicating our new Advanced Coding Strategies seminar that we held in Dallas a couple weeks ago. I’m very happy with how it turned out.

Advanced Coding Example

Here is an example note for a complicated chronic patient. Read the note and answer the following questions: (1) What should be the level of service (99213, 99214, 99215) for this patient? (2) What is this note as written? (3) What is missing?

History of Present Illness:
Patient is here for the first time in 2 and ½ years for refills on his meds. His cardiologist has encouraged him to seek out PCP care more regularly. He has not been having any symptoms lately but has noted decreased stamina of late. He has been taking his meds routinely but they were curious about Niacin. He has been having some intermittent right toe pain and has had circulatory problems in the past including some discoloration of his toes. Finally, he has been constipated of late similar to bouts he has before and he is taking something daily for it.

Medical/Social/Family History reviewed with patient today:
Medical History: Immunizations not up to date.
Allergies: No known drug allergies.

Current Medical Diagnoses:
  • CAD
  • Hyperlipidemia

Current Medications:

  • VITAMIN C 500MG TAKE 1 BY MOUTH DAILY
  • MULTIVITAMIN OTC TAKE 1 BY MOUTH EVERY DAY
  • ASA (ASPIRIN) 325MG TAKE 1 BY MOUTH EVERY DAY
  • BENICAR 20MG TAKE 1 BY MOUTH DAILY
  • ZIAC 2.5/6.25 TAKE 1 BY MOUTH DAILY ON MWF
  • LIPITOR 40MG TAKE 1 BY MOUTH DAILY
  • K-DUR 10MEQ TAKE 1 BY MOUTH DAILY

Hospitalizations: 1998 CVA with CABG.

Surgeries:

  • 1944 ruptured appendix
  • 1946 Amputation (traumatic) of distal phalynx 3 and 4, right hand
  • 1982 AAA repair
  • 1998 CABG x 3.

Social History: Tobacco Use: Denies tobacco use. Alcohol Use: Denies alcohol use. Retired in 1988.

Review of Systems:
All systems reviewed and are negative unless noted in history.

Physical Examination:

  • Vital Signs: Weight: 76.3 kg Pulse: 78 Resp: 20 Sys BP: 174 Dias BP: 90
  • Constitutional: Well developed, well nourished.
  • Skin: Normal to palpation. No rashes or lesions.
  • Psychiatric: Oriented to time, place, and person. Judgment and insight appear normal.
  • Ears, Nose, Mouth, Throat: Ears and nose appear normal. Tympanic membranes and canals within normal limits. Oropharynx within normal limits.
  • Neck: Supple, no bruit, JVD or thyromegaly
  • Lymphatic: No cervical, no supraclavicular nodes.
  •  Cardiovascular: Regular rate and rhythm without murmur. No edema.
  • Respiratory: Normal respiratory effort. Clear to auscultation.
  • Gastrointestinal: No masses, tenderness, or organomegaly.
  • Musculoskeletal: Normal gait and station. No cyanosis or clubbing.

Procedure(s):

  • Venipuncture (36415): VENIPUNCTURE: CBC CMP PSA TSH
  • Lipid profile (80061): Trig 148; Total Chol 159; HDL 20; LDL 109; VLDL 30; TC/HDL 7.9
  • Electrocardiogram, complete (ECG) (93000): Sinus bradycardia, bifascicular block.

Assessment:

  1. Hypertension, benign essential (401.1)
  2. CAD (414.9)
  3. Hyperlipidemia (272.4)
  4. Aneurysm, abdominal aortic (441.4)
  5. Constipation, unspecified (564.00)

Plan: (Start)

  1.  NIASPAN 500 ER TAKE 1 BY MOUTH DAILY
  2. MIRILAX 17GM TAKE 1/2 - 1 CAPFUL DAILY (Refill)
  3.  VITAMIN C 500MG TAKE 1 BY MOUTH DAILY 
  4. MULTIVITAMIN OTC TAKE 1 BY MOUTH EVERY DAY
  5. ASA (ASPIRIN) 325MG TAKE 1 BY MOUTH EVERY DAY
  6.  BENICAR 20MG TAKE 1 BY MOUTH DAILY
  7. ZIAC 2.5/6.25 TAKE 1 BY MOUTH DAILY ON MWF
  8. LIPITOR 40MG TAKE 1 BY MOUTH DAILY
  9. K-DUR 10MEQ TAKE 1 BY MOUTH DAILY (Appts)
  10. Follow-up sonogram of AAA and right LE arteries
  11. Cardiology appt for f/u stress testing
    Follow-up: 3 months fasting and PRN
Now watch the video from the conference to see how you did.

Coding Growth Strategies 2012

We are just about done finalizing our 2012 Coding Growth Strategies calendar. We will be holding 5 conferences from February through April of next year. Right now the planned venues include Dallas, Las Vegas, Atlanta, Philadelphia, and Chicago. We should have the final dates firmed up in the next few weeks and will let you know as soon as we do.

Webinars

In a couple of weeks I’m going to be starting our new webinar series. There are many topics that I’ve been asked to cover that we simply don’t have time to do during our seminars. Also, many of these topics lend themselves much better to a one hour seminar. The webinar format is very exciting in that neither you nor I have to leave our practices, fly or drive somewhere, stay in a hotel, etc. Our typical attendee is usually out over $1500 to attend a 4-6 hour conference. It typically takes about $13,000 to put on a conference. And neither of those figures count in the lost revenue we both face by leaving town.

Our first one will be 2012 CPT changes for Primary Care and will be held on Thursday November 10th at 12:00 noon (central standard time). This is an important topic to all of us and there are several changes this year that impact primary care practices.

The next one will be The Modifiers Every Primary Care Practice Must Know. It will be on Thursday, November 17th at 12 noon (CST). At every seminar we always get lots of questions about modifiers and in the past few years we have seen many practices get hurt financially for not using the correct modifiers.

Attendance is $99.95 per office. During the webinar you can have as many people as you like view and listen to the seminar. We will have a moderator that takes your questions as you type them and will have some time at the end of the hour to discuss them all. The webinar will be recorded and you will be sent the recording to watch again or have your employees or colleagues watch when they have time. If you are unable to attend at this time, you can order the recording on the website and it will be sent to you within 24 hours of the completed webinar.