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codecrazy

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I understand that on a consult 3 of 3 keys must be met or exceeded to code a level. If not met level drops to lower level that all 3 meet. I have a cpc E/M that has 15 years experience auditing it at the higher level that only 2 keys meet. How do I handle this.
 
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The CPT book itself tells us "Office and inpatient consultations require these 3components". I don't know how you will handle this, but I would suggest you to open the CPT book consultation area and show her what the book tells us. It is written right after every consult code (99241-99255).
Hope this helps,
Lilit
 
lmartirosyan is correct...pull out your current CPT book (2009) - go under the consult codes and after each code it states "OFFICE CONSUTLATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 COMPONENTS" and it goes on to list what level of component each code requires to support it. If your co-worker with 15 years experience has been coding consults otherwise, she's been doing it wrong... it's quite clear in the guidelines, and on any E/M score sheet.
you are correct, if all 3 components aren't met, the level drops to the one where all three components are met
 
audit

Well it gets even more complicated, they are auditing charts coded by someone else that were done before I started working. So, I am going to have to tell my boss that his errors are worse and tell this Medicare auditor with more credentials and more experience that she's wrong. I feel like a wet behind the ears upstart that is going to get slapped down by someone. This is a rough business and not for the faint hearted.
 
unemployment

I have a feeling my boss who fires people on the spot will put a notch on his belt for me. But, ya gotta do what you gatta do.
 
E/M

If you go to your boss with "all your ducks in a row" ie, written documentation from the CPT book and from Medicare, I don't understand how he could justify not agreeing with you, let alone firing you. If that is the case I would start looking for employment elsewhere. You don't want to jeopardize yourself because your employer is knowingly billing incorrectly. As they say CYA!
 
the way you present the issue matters also! Do not be judgemental or point fingers. Don't say the other person is "wrong",...just show the proof you have for doing it correctly, be strong in your opinion without being critical of others. We all learn from our mistakes, and we all make mistakes - AND should be willing to change wrong/bad habits when proof is given on how to do it correctly...
 
I agree with Cheermom, that if he makes you to do the same wrong thing over and over again, then you need to change your job because one day you'll be audited by Medicare and...
 
Did I read that right?

Vermonter ... did I read your statement correctly? The "more experienced" person is a MEDICARE AUDITOR?

If that's the case, I would ask her to explain to me, the newbie, about coding E/M, and take out the CPT book with the guidelines, so you can "underline and understand." Let her discover the rules for herself as she explains them to you. Then SHE can tell the doc about his errors.

If she doesn't concur, in the face of concrete evidence, then I'd wait until after she leaves the office to educate the physician. But given what you've said about his propensity to "fire on the spot" be prepared to look for another job.

Your understanding of the guidelines is absolutely correct.

F Tessa Bartels, CPC, CEMC
 
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