Does Your Coding Match The Level of Care?

Lately many health care providers have been complaining about an un-justified level of E/M Billing. The physician community thinks that there is actually more time consumed in reviewing the patient’s past medical history in counseling and in an evaluation in a face to face encounter then claimed in CPT: 99213 level III E/M Code most frequently used by all physician and practices.

Quit often medical billers and providers confuse the coding guidelines for 99213 when it says that 2 out of three key components must be required. (Setting apart the time consumed.) Those component are:-
• Detailed problem focused history.
• Detailed examination.
• Low complexity medical decision making.

Physician practices often lose collections when the key components are missing and when under estimating the time consumed in delivering services. For a citation, a patient appeared back in an office with results on diagnostic tests. The physician didn’t have a detailed medical history review or a detailed examination. The actual face to face encounter lasted more than 20 minutes while counseling the patient on the reports outcome, medication dosage guidance and symptomatic counseling. If the total face to face encounter lasted more than 20 minutes the physician could still claim Level IV CPT: 99214

This slight adjustment after a proper review of your patient encounters and health records can increase the collections from $15 to $20 per service. If an average increase of $18.00 is realized from correcting under coding, this can increase revenues by $95,000 per annum to a practice seeing 20 patients a day.

With proper EMR and practice management tools, the efficiency in offices can be greatly improved. Analyzing encounters and coding can uncover many opportunities. We often find that an analysis of these procedures is time well spent. The expertise that comes from state of the art coding tools and constant updating of software can make a difference.

At Medcare MSO we make every possible effort to find out more ways to increase the revenue streams of our clients. We make sure that your codes are compliant with current laws and you are getting reimbursed for what you truly deserve.

To learn more please sign up for our free practice analysis. Find out if your coding is in compliance and if you are getting full reimbursement for services delivered.