Urology Coding Alert

If your physician is stuck in a coding rut, give him the tools to get on track Do you have one urologist on staff who reports level- four E/M codes for every visit? If you thought your practice was immune to this type of error, your self-audit might uncover problems you didn’t know you had.
 
If you code the charts of several physicians at the same practice, it may be difficult to notice trends in the urologists’ coding habits.
 
For instance, one physician might code every visit as a CPT 99214 , but because her charts are mixed in with other physicians’ in the practice, you don’t notice the pattern because you never code a stack of her charts at the same time. In addition, because many practices now have their urologists do their own E/M coding, you may have never reviewed an E/M chart to check on its accuracy. E/M Coding Inaccuracies Can Be Costly Your self-audit can bring this sort of problem into the light, and coders tell us that it’s their physicians’ number- one coding error.
 
“One of our urologists codes everything as 99214 (office visit) or 99244 (consultation) because he says that every patient he sees has a presenting problem of moderate to high severity,” one subscriber tells Urology Coding Alert. “He pointed out the notation in CPT Codes that states that 99214 and 99244 represent ‘presenting problems of moderate to high severity’ to show me that he’s correct in always billing those codes. The problem is, he doesn’t meet the other criteria of the codes,” she says. Remind Your Physicians How to Choose a Level Nationwide audit statistics show that physicians bill the appropriate E/M level to Medicare only 20 percent of the time, says Stephen Levinson, MD, author of the AMA’s Practical E/M: Documentation and Coding Solutions for Quality Patient Care.
 
If you find E/M coding problems in your chart review, you should remind your physicians how to select the correct level. First, reinforce to the physicians that the nature of the presenting problem will set the initial level of care that is warranted, Levinson says.
 
“After taking the patient’s history of present illness, previous medical history, social history, family history, and review of systems (including updates of PFSH and ROS for established patients), the physician should have a pretty good idea with what level of illness they’re dealing with,” Levinson says. “At that point, the physician should do the exam and medical decision-making that meet the level that’s warranted for that illness severity, based on the patient’s history.” Complexity, MDM Vary With Each Patient If [...]