Physicians Practice - April 2008 - (Page 71)

CODING YOUR TOP CODING CONCERNS SOLVED USING TIME TO CODE FOR OFFICE VISITS; WHO, WHAT, WHEN, WHERE, AND WHY? BY BETSY NICOLETTI AND NANCY READING If you’ve ever read a patient the Riot Act, use time to document that visit. Most physicians know they can use time to select a code for an ofﬁce visit or consult, but many forget when, why, and how to do it. According to the CPT book and documentation guidelines, if you spend more than half the visit discussing the patient’s illness and treatment, use time to select the code rather than the level of the history, exam, and medical decision-making you perform. Here are some examples: • An endocrinologist sees a diabetic patient. After a brief history and exam, they talk about diet, blood sugar monitoring, the importance of tight control, and medication adjustments. • An oncologist sees a patient for follow-up, and the patient’s cancer has not responded to the ﬁrst course of treatment. The entire visit is spent discussing other treatment options. • A depressed patient returns to her primary-care physician after pharmacological treatment is initiated. They discuss her symptoms, response to medication, and side effects. Some visits don’t require an exam and only necessitate minimal historytaking because the physician has recently seen the patient, or because the information about the patient’s illness is derived from data as much as from the patient’s description of her symptoms. If you use time to code a visit, document the total time spent with the patient. Document that more than 50 percent of the visit was spent in discussion. Describe the discussion. Then select the code based on time. You WWW.PHYSICIANSPRACTICE.COM should only take into consideration the face-to-face time you spend with the patient. Staff time doesn’t count. For hospital visits, count unit time. Use time only for codes that are listed as typical times in the CPT book. WHO, WHAT, WHEN …? the patient’s symptoms or known diagnosis. “Why” is often the source of denial. The payer doesn’t think the patient’s condition warranted the service. Answer these questions on your claim form, and you’ll be more likely to receive timely payment. YOUR CODING Q&AS Completing a CMS 1500 form is like constructing the plot of a whodunit novel. But in this case, it’s not the butler. If your practice wants to get paid the ﬁrst time, it must complete the CMS 1500 as if it were solving a mystery story. Answer the following questions: • Who is the patient? Who is the subscriber, and from which group? Who provided the service? Enrollment staff can provide the accurate NPI and other identifying provider numbers on the claim. Who referred the patient to your practice? • What? Your practice doesn’t describe the procedure in words to the insurance company. Rather, it must select a ﬁve-digit CPT or HCPCS code that accurately tells the payer what service was provided. Was it an ofﬁce visit? Appendectomy? CBC? Was the procedure open or endoscopic? The modiﬁer, a two-digit code appended to the procedure, tells the payer the circumstances of the situation. Yes, it was done twice (-50). It was a separate procedure (-25, -59). It was unusually difﬁcult (-22). This is the claim for the assistant (80, AS). • When was the date of service? • Where was the service provided? At the ofﬁce, nursing home, or hospital? • Why did you provide the service? What made it necessary? The diagnosis code tells the payer • Admissions to Day-Stay Units Q I can’t seem to locate in the CPT codebook which E&M code I should use when admitting a patient to a medical or surgical day-stay unit. Can you help? A If you are admitting a patient to a medical or surgical day-stay unit and subsequently providing other services, it may be that the E&M service-of-admission code is included in the procedure’s global package. It would only be appropriate to code for the E&M service if it was signiﬁcant and separately identiﬁable from the surgical procedure (use the -25 modiﬁer), or if the decision to perform the additional procedure was made on admission for the pre-planned procedure (use the -57 modiﬁer). In these situations, you must sort through several variables on a caseby-case basis to protect you from the unnecessary risk associated with over-coding. • This month’s coding experts are Betsy Nicoletti, MS, CPC, author of “The Field Guide to Physician Coding” and “The 2007 Physician Auditing Workbook,” and Nancy Reading RN, BS, CPC, director of education at the American Academy of Professional Coders. They can be reached via info@physicianspractice.com. APRIL 2008 | PHYSICIANS PRACTICE | 71 http://WWW.PHYSICIANSPRACTICE.COM

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Physicians Practice - April 2008 Contents The Bigger Picture: Medicare Decision Time Letters Physicians Practice Pearls: Outsource Your Pain Noteworthy Cover Story: Trial Lawyers Tell All Management: When It’s Time to Change Ask the Experts Technology: Do You Know Where Your Data Is? The Tech Doctor: Are Your Discarded PCs Really Clean? Billing & Collections: Playing Hardball The Administrator's Desk: Recruiting for Patient Satisfaction Start It Up: Finance - Mastering the Numbers Game Coding The Great Practice Makeover: Taking Care of Business Associates Classifieds Advertiser Index

Physicians Practice - April 2008

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