Changing to the Proper CPT Code During a Routine Office Visit
Posted on July 17, 2011 | No Comments
Adam Alpers asked:
Though medicine is considered to be an ethical profession and deals with proper reporting and honesty from both the sides (patients – doctors), there are certain ways and methods to earn more revenue from simple office visits. As a medical provider, you might face various cases of diverse magnitude in your office, from a simple cold to a serious life or death situation, for example, a patient having a seizure. When you finish the treatment, the next stage comes when you need to code the steps for a medical claim. Now here comes the tough task of assigning the right code for the correct situation and then claiming the money for the entire encounter performed. Basically, you are paid for what you code is the underlying fact.
Charging the office visit is the process that is self explanatory and is used by medical practitioners to reflect the “case” of a patient, and assign codes that are related to the office visit or encounter to obtain the highest return monetarily allowed. In simple words, when a patient comes to you for a general cold and the visit lasts just a few minutes, the reimbursement as such will return less than a more complex scenario that may include an acute episode of shortness of breath. The general step that can be done is assigning a code that gives a higher rate of return and then submitting it for the claim when appropriate. It means that when you perform a more comprehensive visit, and or more critical services were rendered the code should be reflective of this and the payment is more.
The entire issue about how to take appropriate advantage and when to increase the level of service remains a delusion in most provider`s mind. The right way to address this issue through proper knowledge of the coding standards and to ethically decide and generate a plan that will satiate both the requirements (your coding for reimbursement and the relationship to the illness) in a good manner.
One possible way of accomplishing maximizing the coding issue discussed, for example, is by stating in the record that the patient was suffering from severe bronchitis and breathing impairment requiring critical attention and immediate need for the use of oxygen and a nebulizer treatment in one scenario, versus just mentioning the patient was a little short of breath and leaving out the need for the oxygen and a nebulizer treatment; even though you supplied these services in the office. This is an example of a typical case in which we see every day, and subsequently miss the chance of coding the maximum reimbursement for that visit.
Other issues arise when the patients are sometimes clever and take one more moment in an informal way. This is generally seen when a patient comes to you and says “oh by the way just one more thing” and then goes on to discuss another issue during that same office visit about his ailment and gets an informal suggestion that goes both uncharted and hence unbilled at the maximum.
These scenarios are becoming more frequent in number due to the hectic lifestyle of today. Patients come in for a particular problem and then the focus changes entirely to a new attribute which is different from the case they came for. This “free advice” can either be a stream of lost revenue, or be properly utilized to maximize the office visit charged. The increased revenue earned is phenomenal in some cases. Make sure that when you offer suggestions you still document those “off the cuff” and “by the way” requests as then the coding is properly linked to the documentation when you actually submit the claim for reimbursement.
Coding can sometime be complicated for these types of encounters. It is best to have a thorough understanding of the requirements involved in the proper coding of the office visit encounter to capture the maximum reimbursement allowed for the treatment rendered.
Kansieo.com
Though medicine is considered to be an ethical profession and deals with proper reporting and honesty from both the sides (patients – doctors), there are certain ways and methods to earn more revenue from simple office visits. As a medical provider, you might face various cases of diverse magnitude in your office, from a simple cold to a serious life or death situation, for example, a patient having a seizure. When you finish the treatment, the next stage comes when you need to code the steps for a medical claim. Now here comes the tough task of assigning the right code for the correct situation and then claiming the money for the entire encounter performed. Basically, you are paid for what you code is the underlying fact.
Charging the office visit is the process that is self explanatory and is used by medical practitioners to reflect the “case” of a patient, and assign codes that are related to the office visit or encounter to obtain the highest return monetarily allowed. In simple words, when a patient comes to you for a general cold and the visit lasts just a few minutes, the reimbursement as such will return less than a more complex scenario that may include an acute episode of shortness of breath. The general step that can be done is assigning a code that gives a higher rate of return and then submitting it for the claim when appropriate. It means that when you perform a more comprehensive visit, and or more critical services were rendered the code should be reflective of this and the payment is more.
The entire issue about how to take appropriate advantage and when to increase the level of service remains a delusion in most provider`s mind. The right way to address this issue through proper knowledge of the coding standards and to ethically decide and generate a plan that will satiate both the requirements (your coding for reimbursement and the relationship to the illness) in a good manner.
One possible way of accomplishing maximizing the coding issue discussed, for example, is by stating in the record that the patient was suffering from severe bronchitis and breathing impairment requiring critical attention and immediate need for the use of oxygen and a nebulizer treatment in one scenario, versus just mentioning the patient was a little short of breath and leaving out the need for the oxygen and a nebulizer treatment; even though you supplied these services in the office. This is an example of a typical case in which we see every day, and subsequently miss the chance of coding the maximum reimbursement for that visit.
Other issues arise when the patients are sometimes clever and take one more moment in an informal way. This is generally seen when a patient comes to you and says “oh by the way just one more thing” and then goes on to discuss another issue during that same office visit about his ailment and gets an informal suggestion that goes both uncharted and hence unbilled at the maximum.
These scenarios are becoming more frequent in number due to the hectic lifestyle of today. Patients come in for a particular problem and then the focus changes entirely to a new attribute which is different from the case they came for. This “free advice” can either be a stream of lost revenue, or be properly utilized to maximize the office visit charged. The increased revenue earned is phenomenal in some cases. Make sure that when you offer suggestions you still document those “off the cuff” and “by the way” requests as then the coding is properly linked to the documentation when you actually submit the claim for reimbursement.
Coding can sometime be complicated for these types of encounters. It is best to have a thorough understanding of the requirements involved in the proper coding of the office visit encounter to capture the maximum reimbursement allowed for the treatment rendered.
Kansieo.com