Transcript Coding Tips and Other Strategies to Increase Practice Revenue

Coding Tips and Other
Strategies to Increase
Practice Revenue
Cynthia W Denmark, FNP-BC,
Wesley Primary Care-Leakesville
Wesley Medical Center
Disclosure of Financial
Relationships
Cynthia W Denmark, FNP
Has no relationships with any proprietary entity
producing health care goods or services
consumed by or used on patients.
Objectives
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The participant will be able to:
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Evaluate the financial status of the clinical practice
Identify common causes of lost revenue
Identify opportunities for additional sources of income
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Know Your Financial Status
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Know your largest payer
Request a monthly/quarterly statement
Meet with CFO quarterly
Common Causes of Lost
Revenue
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Office procedures
Codes not recognized by payers
Collections
E&M Miscoding
Common Causes of Lost Revenue:
Office Procedures
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Destruction of Benign Lesions (Cryo)
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Bicillin CR 1,200,000/2mL
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Keratoses (17000/1; 17003/2-14)
Warts (17110/1-14)
$13/unit + injection fee
Shave Biopsy
Injection fee
Venipuncture
Pap Smears
Common Causes of Lost
Revenue
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ICD codes no recognized by Payers
Benign Lesions
 Fatigue
 Vitamin D
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Collections
E&M miscoding
Seek Additional Revenue
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Contract with Businesses
See Pts in LTCF
House Calls
Group Visits (SMA)
Case Study #1
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Established pt
cc: sore throat
HPI: 23 yo F c/o sore throat “hurts to swallow”,
fever>101. The problem started suddenly
yesterday. She took ibuprofen last night & this
morning. Nothing relieves the pain. Her child is
currently taking amoxicillin for strep throat.
Case Study #1
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SH: quit smoking 2 yrs ago
ROS: no ear pain, no sinus pressure or drg, no cough or
chest tightness/pain
Exam: BP 112.68 HR 72 RR 18 T 100.8
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Eyes: non-injected, no drg
ENMT: TMs clear, no nasal drg, Tonsils
enlarged/erythematous with exudates
Neck: cervical lymph node tenderness
Lungs: BBS CTA CV: RRR, no murmur
GI: no splenomegaly; abd soft, non-tender
Skin: no rash
Case Study #1
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Labs: rapid strep (positive)
Impression/Plan:
Streptococcal Sore Throat
 Bicillin CR 12 units IM now
 Alternate Tylenol & Ibuprofen q 3 hrs prn
fever/pain
 Chloroseptic lozenges for sore throat
 Discard toothbrush
 RTC if symptoms persist/worsen
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Case Study #2
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cc: f/u DM, dyslipidemia, HTN
HPI: 68 yr M presents for refills and f/u. FBG
was 118 this a.m. His previous TG was slightly
elevated at 162 and has since been taking
2000mg fish oil daily along with his lovastatin.
His BP is controlled by diet & lisinopril 10mg
daily.
Case Study#2
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PFSH: reviewed with no changes
ROS: denies SOB, chest pain
Exam: BP 130/78 HR 72 RR 20 T 98.8 BMI 29
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Overweight; normal affect; BBS CTA; RRR; no
murmur;
Impression/Plan
DM, Dyslipidemia, HTN
 Continue current medications
 RTC in 30 days for labs (A1c, Lipids, CMP)
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E&M Coding (Est. Patient)
CPT
99212
99213
99214
99215
HPI
ROS
PFSH
1
1
1
4 (3 chronics)
4 (3 chronics)
2
1
10
2
Exam
1
2
5
8
MDM
SF
Low
Mod
High
Time
10 min
15 min
25 min
40 min
E&M Coding (New Patient)
CPT
99201 99202
99203
99204 99205
HPI
ROS
PFSH
Exam
1
1
1
1
2
4
2
1
5
4
10
3
8
4
10
3
8
MDM
SF
SF
Low
Mod
High
Time
10
20
30
45
80
Pearls for Documenting
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Have Nurse/MA document history & ROS
(You must document that you reviewed)
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Risk: moderate risk=level 4 visit
Prescription drugs
 1 chronic illness w/ progression or SE of tx
 2+ stable illnesses
 Undiagnosed new problem
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Pearls for Documenting
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Document ALL exam elements. There are 7 elements
to document PRIOR to the “examination”
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General appearance
Eyes: injected, no drg
ENT: hearing intact
MSK: normal gait/limp
Psych: normal affect, depressed, agitated
Skin: no rash on face/arms
Immunologic: NKDA (use of PMH or PE)
Pearls for Documenting
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Avoid “all others negative” for ROS. State the #
of systems reviewed.
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Avoid “non contributory” or “not significant to
current illness” for PFSH. Recommend “was
reviewed and is negative”