Module 05 Assignment - Coding Compliance: Analyze, Investigate, and Take Action In this assignment, you will take on the role of a Coding Manager who has been summoned to the Chief Medical Officer’s (CMO) office. The CMO has expressed a concern about the coding for Internal Medicine (IM) physicians because she has received some complaints. Some IM doctors indicate that pay amongst the IM doctors is varying a great deal, and they want to make more money, as well. Since physician pay is driven by Evaluation and Management (E&M) coding assignment, the CMO wonders if the coder is new. You explain that there are several coders in the IM area since coders are cross trained over many specialties for vacation coverage. You indicate that you will track 100 accounts for each of the nine (9) IM providers and will use the national comparative data to identify possible coding problems. Your analysis will require you to: Part I: interpret data that has been collected Part II: manipulate the data Part III: determine if you need to make changes to your coding staff and report back to the CMO Part I – Interpret the Data Chart 1: Here is the national comparative data for physician E&M level assignment. Source: Medicare Provider Utilization and Cost Physician and Other Supplier NPI Aggregate, 2013.The detailed NPI and HCPCS data file can also be used to examine how patterns of service use vary across physicians and specialties. Chart shows the distribution of routine office visits (a.k.a., Evaluation and Management services) for some common specialty types. Medicare has five different HCPCS billing codes (99211-99215) for routine office visits based on the length of the visit ranging 5 minutes for 99211 (level 1) to 40 minutes for 99215 (level 5). As may be expected, specialties such as Dermatology bill a higher proportion of shorter-length office visits (e.g., level 2) than Internal Medicine or Nurse Practitioners, whereas specialties such as Cardiology and Hematology/Oncology bill a higher proportion of higher-length office visits (e.g., levels 4 and 5). --Continued on next page-- 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Internal Medicine Cardiology Nurse Practitioner Opthalmology Dermatology Hematology/ Oncology E&M Level Assignment, Provider Type 99211 99212 99213 99214 99215 The following questions use the information provided above. 1. Which Specialty type averaged 28% of E&M level 99212? a. Cardiology b. Internal Medicine c. Dermatology d. Ophthalmology 2. Which Specialty type has the highest average in E&M level 99215? a. Hematology/Oncology b. Cardiology c. Dermatology d. Ophthalmology 3. Which E&M level has a routine office visit with a length of visit equal to 40 minutes? a. 99214 b. 99215 c. 99213 d. 99212 Chart 2: Further comparative data includes the typical reimbursement for each level. E&M Level Average Reimbursement Internal Medicine Breakdown from Chart 1 Level 99211 $18.46 ...