Physicians Practice - October 2008 - (Page 38)

MANAGEMENT coding, and, largely because of fears of being audited, they choose a lower, less ﬂag-raising code. Since E&M codes are the mainstay of primary-care coding, this play-it-safe mentality costs their practices a fortune. Consider that if you collect the $21 difference between a 99213 and a 99214 just twice a day, every day, for a year, you’d bring in nearly $11,000 in additional revenue. The key to solving this is to educate yourself so you can conﬁdently code as highly as appropriate for every patient visit. And it does matter, ﬁnancially speaking. So the point is this: Provided you know what you’re doing, you have total control to code at higher levels — legally. And you should. It’s your money; why shouldn’t you collect it? But it’s on you to code correctly. Otherwise, payers will happily — and lawfully — keep what’s rightfully yours. They don’t care if you undercode, and indeed, why should they? Three factors determine an E&M code: the amount of history taken; the level of detail of the exam; and the level of decision-making. The chart on page 36 (though far from a complete rubric for properly determining a visit code) illustrates how to classify your patient exams. Don’t let semantics and numerical positioning confuse you. A straightforward ofﬁce visit, or 99213, falls in the middle of the ﬁve “established visit” codes. But it’s vital to remember a 99213 is not meant for visits that require a moderate — read, “middle” — level of medical decision-making; that’s 99214 territory. Unfortunately, this is a psychological track hurdle that many physicians fail to clear. It’s also absolutely essential that you comprehend the difference between what you charge and what you get. A good way to illustrate this is to look at the results of Physicians Practice’s annual Fee Schedule Survey, which provides a baseline off of which you can bounce your own fee schedule. For example, in 2007, the reported average amount on 38 | PHYSICIANS PRACTICE | OCTOBER 2008 Southeastern physician fee schedules for a 99213 was $94.12. For a 99214, it was $131.23. Here’s the kicker: It’s what you are paid by the payers that ﬁlls the practice coffers, not what you write in your fee schedule. According to our survey, payers reimbursed on average just $44.14 for a 99213 in the Southeast region — less than half of what physicians there were hoping for. So the most expeditious way to emerge from a 99213 rut is to fully understand what’s going on codingwise; code appropriately — and as highly as possible — and get paid what you deserve. • Shirley Grace is an associate editor on staff at Physicians Practice. She can be reached at sgrace@physicianspractice.com. WWW.PHYSICIANSPRACTICE.COM http://www.medplexus.com http://www.medplexus.com http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - October 2008

Physicians Practice - October 2008 Contents Another Reason to Go Cash-Only? Letters How ’Bout Them Gas Prices? Second Opinion: Oh, Canada! Noteworthy Cover Story: Fixing the Leaks: How to Tighten Your Money Spigot Navigating a Lawsuit Ask the Experts The Administrators Desk: What’s Your Mission? EMR: Help or Hindrance? Dealing with Dr. Dangerous E-Mail Abuse Primer The Road to EMR Interoperability Don’t Let Staff Costs Stifle Profits Coding Classifieds Advertiser Index

Physicians Practice - October 2008

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