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consults

  1. #1
    Default consults
    Exam Training Packages
    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.
    Last edited by codecrazy; 01-08-2009 at 08:02 PM. Reason: spelling

  2. #2
    Location
    Woodland Hills, CA
    Posts
    121
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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
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  3. #3
    Location
    Duluth, Minnesota
    Posts
    1,133
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    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
    Donna, CPC, CPC-H

  4. #4
    Default 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.

  5. #5
    Location
    Woodland Hills, CA
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    121
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    Vermonter,
    Please keep us posted as how you handled this situation.
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  6. #6
    Cool 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.

  7. #7
    Location
    Evansville Indiana
    Posts
    451
    Default 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!

  8. #8
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    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...
    Donna, CPC, CPC-H

  9. #9
    Location
    Woodland Hills, CA
    Posts
    121
    Default
    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...
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  10. #10
    Location
    Milwaukee WI
    Posts
    4,466
    Default 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
    Last edited by FTessaBartels; 01-09-2009 at 01:01 AM.

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