E & M Coding: Are You Leaving Money on the Exam Table?

Transcription

1 Welcome To The Digital Learning Center Presented by Your Partner In Building High Performance Practices Today s Presentation E & M Coding: Are You Leaving Money on the Exam Table?

2 Course Faculty R. Thomas (Tom) Loughrey, MBA, CCS-P Chairman & Co-Founder of Economedix Certified Coding Specialist BS Degree from Pennsylvania State University Earned an MBA in Health & Hospital Administration from the University of Florida Former Hospital Administrator Former Owner of a Medical Billing Company Consultant to Physician Practices & Medical Societies Member of Various Professional Organizations Dealing with Medical Practice Management Developed and Presented Thousands of Seminars & Workshops Dealing with Practice Management Course Overview Coding Patterns Financial Impact Inpatient Consults Outpatient Consults New Patient Office Visit Established Patient Office Visit Summary

3 New Patient Coding Patterns Blue: Practice Maroon: Medicare Est. Patient Coding Patterns Blue: Practice Maroon: Medicare

4 Financial Impact Practice Coding Pattern: 65% and 20% Medicare Coding Pattern: 55% and 32% Difference of $32,840 The Inpatient Consultation Case Study # 1

5 The Inpatient Consultation Patient referred for possible cholecystis The Inpatient Consult - History

6 The Inpatient Consult - Exam The Inpatient Consult Decision Making

7 The Inpatient Consult Decision Making The Inpatient Consult Decision Making

8 The Inpatient Consult Decision Making The Inpatient Consult Decision Making

9 The Inpatient Consult - Summary What if we made just one change? Let s go back and take a look at the Review of Systems in the History section

10 The Inpatient Consultation with Changes The Inpatient Consultation with Changes Just completing the ROS changed this to a comprehensive history and raised the level of documented coding to a 99255

11 The Inpatient Consultation with Changes Just completing the ROS changed this to a comprehensive history and raised the level of documented coding to a And the revenue changes from $ (99253) to $ (99255) a difference of $86.61 Same scenario but an office based consultation

12 Office-Based Consult - Exam The New Patient Office Visit Case Study # 2

13 The New Patient Office Visit New patient being seen for weight loss, frequent and urgent urination particularly at night, thirst accompanying frequency of urination. New Patient Office Visit - History

14 New Patient Office Visit - Exam New Patient Office Visit Decision Making

15 New Patient Office Visit Decision Making New Patient Office Visit Decision Making

16 New Patient Office Visit Decision Making New Patient Office Visit Decision Making

17 New Patient Office Visit - Summary Counseling During Office Visit What if 35 minutes of counseling is documented and the visit is 65 minutes?

18 Counseling During Office Visit Because counseling is documented in the medical record along with the time required for the counseling and the total time of the encounter the code is based only on time. Counseling During Office Visit The revenue changed from $97.79 (99203) to $ (99205) or a difference of $92.63

19 The Established Patient Office Visit Case Study # 3 The Established Patient Office Visit Diabetic patient in for a recheck after two months. Lab work including HbA1C was done prior to appointment. Checking medications and current status including compliance with dietetic and lifestyle instructions.

20 Est. Patient Office Visit - History Est. Patient Office Visit - Exam

21 Est. Patient Office Visit Decision Making Est. Patient Office Visit Decision Making

22 Est. Patient Office Visit Decision Making Est. Patient Office Visit Decision Making

23 Est. Patient Office Visit Decision Making Est. Patient Office Visit Summary

24 What if we made just one change? Let s go back and take a look at the Exam section and do a ENT exam What if we made just one change?

25 What if we made just one change? With this one extra addition the revenue went from $65.64 (99213) to $98.46 (99214) or a difference of $32.82 Summary Document exactly what is done Code to the documentation Do not do more than is medically necessary Measure your performance against Medicare Standards Don t leave any money on the exam room table