Wiki maximizing RVUs

[Nadialafleur]

Question: I received an email from someone who's the head of a clinic asking if I can go to a meeting to answer coding questions to help with maximizing their RVUs. The issue is, I was told we as coders are NOT allowed to tell physicians what to do in that regard except when it has something to do with correcting errors. To be honest, I don't feel comfortable with it. It'll feel like I'm telling them how to stretch the truth just so they can get more RVUs. Has anyone had an issue like this?

 

[pscanlan]

Question: I received an email from someone who's the head of a clinic asking if I can go to a meeting to answer coding questions to help with maximizing their RVUs. The issue is, I was told we as coders are NOT allowed to tell physicians what to do in that regard except when it has something to do with correcting errors. To be honest, I don't feel comfortable with it. It'll feel like I'm telling them how to stretch the truth just so they can get more RVUs. Has anyone had an issue like this?

Literally every physician I've ever worked with has asked this at one point or another. If they're not asking about RVUs, they're asking about some code that they heard about from their friend who runs a practice in BFE that they can bill instead of E/Ms for more money. It's a fine line, to be sure. You don't want to be driving medical decision making, yet you want to maximize the revenue they collect for the services they provide. Depending on how deep you are into revenue cycle management (and what sort of organization you're in) you may be asked to make recommendations like this.

It would definitely depend on how the questions are phrased. If they ask "does code X or code Y reimburse more?" you're kind of obligated to tell them which one pays more. If they ask "which should I bill?" well that's where your opinion as a coder should be valued. I tend to err on the side of caution when making recommendations. If an anesthesiologist asks me why we can't bill for NG/OG tube placement when they've done general anesthesia, I make no bones about telling them that's unbundling and specifically verboten (they don't ask this in actuality, but they still circle it on their billing sheets).

I mean when they say "maximizing their RVUs" do they mean only doing procedures with high RVU base values? or cramming more RVUs into a day? There are a lot of directions one could take that inquiry. I wouldn't be afraid of discussing it with the practice manager. I really don't know how to address your concern, as I've had these sorts of conversations at every coding job I've ever had.

 

[csperoni]

The previous post is pretty accurate. As more physicians are becoming employed by large health systems, oftentimes their contract will specify a bonus wRVU level or minimum threshold for wRVUs.
My take on coders is that we clearly are not qualified and should not be directing the clinicians how to best TREAT the patients. However, it is totally within the scope of our training to help clinicians understand the best way to DOCUMENT the care they are ALREADY providing.
Here's a great real life example:
One of my physicians was rounding along with the resident over the weekends. The resident note would even indicate that the physician was present the entire time. Unfortunately, the physician was simply co-signing the resident note and NOT adding the required attestation. So, the physician was providing the care, and if it had been properly documented, it would be billable under teaching physician guidelines. The care was already being provided, it was just not documented according to the rules and regulations that make it billable.
Here's another:
A comprehensive multi-system exam (1995 guidelines) requires documentation of 8 organ systems. There are many specialties (like GI or gyn) that during the exam, they are looking at and noticing if something is abnormal of the skin. But if they are not documenting it (even though they may have looked at it), we can't count it. I have needed to explain to physicians to ensure they document what they examined (even if it's normal). Psychiatric is also something that many providers may be evaluating in their head, but not on the paper.

Assist your providers in understanding the coding rules and regulations that they are not really trained for. It is absolutely OK to advise physicians on the best way to document the care provided. It is absolutely not OK to advise providers that they should examine 8 organ systems just to get a comprehensive exam level.