Medical necessity and training ideas

camilleb

Guru
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Location
Arlington TX
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I would like to ask my fellow coders to please share your ideas on how you were able to successfully teach your doctor EM coding? (Tools you used that were effective) AND
How were you able to get them thinking 'medical necessity' versus how to get that 'extra bullet"?

Thank you in advance! :D
 

melzinser

Networker
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Columbus, OH
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"make a 'knee' a four!"

When first hired, I was told by one Ortho provider, "show me how to make a new patient
knee a four and I'll get you a raise." My response was, "you can't make a knee a our; it either is one or it isn't." Which led to a discussion on medical necessity being the overarching criterion for level selection.

The best training I've done was accomplished with 4 of our providers who allowed me to shadow them during office hours. (It helped that I have a strong clinical background.) I observed in the exam room with the patient's permission and then evaluated the resulting documentation and code selection. I provided suggestions of missed documentation opportunities that were appropriate and would support a higher level code, particularly on the physical exam.

Also, an E & M Documentation & Coding "cheat sheet" is in each dictation area. I've attached a copy. It is Ortho specific, but you could adapt it for a different specialty or just general medical decision making. Hope this helps.
 

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