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Medical Coding 101

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Dr. Lander's presentation on basic coding concepts for residents and new doctors

Dr. Lander's presentation on basic coding concepts for residents and new doctors

Published in: Economy & Finance, Business

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  • 1. Coding 100Richard Lander MD FAAP
  • 2. Why is coding important to me?
  • 3. Coding tells the insurers & auditorswhat the patient’s problems were andwhat you did for them so that you can get paid.
  • 4. Coding is how you will make your living.
  • 5. What is a CPT and where do they come from?
  • 6. CPT codes stands for CurrentProcedural Terminology. It is owned by the AMA. It is revised yearly and it is the standard for all medical billing.
  • 7. What is a RBRVU?
  • 8. RBRVU stands for Resource Based Relative Value Units.
  • 9. RBRVU Developed at Harvard by Dr. Hsai to make Medicare payments more equitable, it is now the standard of payment for many private insurers.
  • 10. What is an ICD?
  • 11. ICD tells whatillness wasdiscovered in yourexaminations
  • 12. ICDs have “severity” scoring systems in existence that look to see that physicians are paid appropriately for the work they deliver
  • 13. Well visits
  • 14. With well visits you only need to know if thepatient is “new” or “established. New patients – one not seen by you or the practice in 3 years
  • 15. Well visitsAge CPT Code New CPT Code EstablishedUnder 1 year 99381 993911 – 4 years 99382 993925 – 11 years 99383 9939312 – 17 years 99384 9939418 – 39 years 99385 99395
  • 16. Evaluation and Management Codes
  • 17. E&M codes are for sick visits. They arebased on the severity of the illness and work done.
  • 18. Note: If more than 50% of visit is counseling, then time is an element
  • 19. New patient codes require all 3 elements New Patients Patients onlyEstablished require 2 out of 3 elements Doesn’t require the presence of a 99211 physician
  • 20. 99212 Expanded problem focused history Expanded problem focused exam Straightforward medical decision making
  • 21. 99213 Detailed history Detailed examination Medical Decision making of low complexity
  • 22. 99214 Comprehensive history Comprehensive examination Medical decision making of moderate complexity
  • 23. 99215 Comprehensive history Comprehensive examination Medical decision making of high complexity
  • 24. Why is this important?
  • 25. Most doctors (pediatricians, actually) under code
  • 26. What does this cost?
  • 27. If you increase from 5% 99214 to 20% , you can increase your net income by $20,000 without doing any more work
  • 28. You don’t want to over code becauseMedicaid and private health insurers canand will audit you. If the documentation doesn’t equal the code billed, they will penalize you
  • 29. Evaluation requested by an appropriate professionalwith a report back to that person 99243 - Consult 99213 – E/M 3.17 x 36.79 1.39 x 36.79 $116.62 $51.14
  • 30. Pediatricians do many procedures
  • 31. If you don’t bill for the procedures you do, you cheat yourself out of the many dollars
  • 32. Subluxation of elbow 24640 99213 4.85x 36.79 1.39 x 36.79 $178.43 $51.14
  • 33. What does this tell you?
  • 34. It is critical to know the codes for all the procedures you do,since obviously procedures pay better than E/M codes
  • 35. Where can you learn more?
  • 36. Decide if the practice you are looking at has someone who knows codingThe Academy offers coding courses – at the NCE and as stand alone courses
  • 37. Other Steps
  • 38. Be sure you have a current CPT and ICD coding books in your office
  • 39. USEThem

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