Physicians Practice - July/August 2008 - (Page 63)

ASK THE EXPERTS YOUR TOP QUESTIONS ANSWERED CHOOSING TECH TOOLS; PAPERWORK PROCRASTINATION; RELOCATING YOUR PRACTICE; STAFF DISPUTES DEFINING “UNDER ANESTHESIA” Q Are you able to clarify code 26340? Does “under anesthesia” mean that the patient needs to be under general anesthesia? Or at a facility using anesthesia other than local? A According to the AAOS, “January 1999 CPT Assistant noted that the phrase “with or under anesthesia” in a code description meant under general anesthesia. But by 2002, this information was outdated and the terms ‘under anesthesia’ or ‘with anesthesia’ are now understood to reﬂect the appropriate anesthesia for a given patient and/or given situation.” (Source: www2.aaos.org/aaos/archives/ bulletin/aug05/coding.asp) Individual payers, of course, may have their own interpretations. THE “RIGHT” EMR AND PATIENT PORTAL fer to document? Via templates? Free text? Voice recognition? After you’ve established your needs, then look for a system to ﬁt them. Since you are looking for both an EMR and practice management solution, consider purchasing one integrated system. This means limiting your search to systems that have management and medical record interfaces running from the same database — a much more seamless and robust solution, compared to systems that essentially patch together information housed separately. Seriously consider a system that is already geared towards pediatrics — one that can, for example, account for the unique dosing requirements of children by automatically adjusting for their growth and age. GETTING EMPLOYED PHYSICIAN TO COMPLETE PAPERWORK If he’s not part of the solution, he’s not likely to adopt it anyway. 2. The partnered physicians need to be the one to hold his toes to the ﬁre. Once he’s accepted a solution and benchmarks for performance, the performance should be measured and shown to him monthly. 3. Schedule time during the day (say 15 minutes after every three appointments) during which he can do his notation instead of at the end of the day. Then it makes less sense to spend time doing it at home. 4. Introduce economic/job security threats. Better to lead the horse to water and have him take a good long guzzle, but if you can’t make him do that, make prompt documentation a condition of employment. I’ve seen practices dock physician pay as well, but it doesn’t always work and indicates that you see a problem in documentation that you are not able to ﬁx — a problem should you be audited down the line. PELVIC EXAM AND PAP SMEAR PAYMENT Q I am a pediatric endocrinologist about to start a solo practice. What parameters should I use to decide which EMR is the best for my practice? I will also set up a Web site for online scheduling, and I am interested in complete software that includes practice management. This is an important decision, and I want to make the right one. A Bottom line: What matters most is what you need the software to do; deﬁne that ﬁrst. Do you just need charts out of an EMR or help coding, reporting to pay for performance initiatives, or outcomes reporting? What work ﬂow solutions are critically important? Do you need a solution that works on a mobile tablet or will desktops sufﬁce? How will you preWWW.PHYSICIANSPRACTICE.COM Q We are a very busy surgical office. Our employed physician is very disorganized when it comes to paperwork. For example, he doesn’t dictate his op reports, which means he is constantly on the delinquent list at the hospital, which means surgeries can not be scheduled. We allow him appropriate time to complete paperwork after clinical hours, but he heads home instead of finishing up. Any ideas what we can do to help him get things in order? A A few suggestions: 1. Ask the physician what is getting in the way and what he’d suggest as a solution (e.g., being able to dictate at home, documenting immediately after surgeries, etc.). Q I have a question concerning billing for pelvic exams and pap smears. I am told they are nonbillable services and that the physicians must just increase his E&M charge to cover it. A Medicare covers both, with certain limitations. Frequency allowed is determined by risk. See: www.cms.hhs.gov/manuals/ downloads/ncd103c1_Part3.pdf. To bill Medicare, you need to use a screening diagnosis code, usually JULY/AUGUST 2008 | PHYSICIANS PRACTICE | 63 http://www2.aaos.org/aaos/archives/bulletin/aug05/coding.asp http://www2.aaos.org/aaos/archives/bulletin/aug05/coding.asp http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part3.pdf http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part3.pdf http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - July/August 2008

Physicians Practice - July/August 2008 Contents The Bigger Picture: Battle Royale in the EMR Market Letters Physicians Practice Pearls: Hire Right Noteworthy Cover Story: Healthcare Reform: Voting for Change Patient Relations: Dealing with Problem Patients The tech Doctor: Is Self-Service Medicine Inevitable? Technology: Do EMRs Make You a Better Doctor? The Guide Idealab: Cash-Only Care Still Works The Administrators Desk: Who’s in Charge? Ask The Experts What Went Wrong: ‘Why Our Great Idea Didn’t Work’ Coding Start It Up: How to Launch a Practice: Operations Partnership: Don't Let Partner Conflict Destroy Your Practice Appraisals: What’s Your Practice Worth? Getting Advice: How to Hire a Consultant Classifieds Advertiser Index

Physicians Practice - July/August 2008

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