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Thread: definition of encounter??

  1. #1

    Default definition of encounter??

    I'm working for a company who is paying X dollars per encounter that I code. I do coding @ home for an orthopaedic surgeon. When I started I took that to mean per date of service coded, or each seperate encounter that the doctor has with the patient, example: Mr. Jones is seen 4/1 for a consultation, and a surgery is done the next day, 4/2, so that's 2 encounters. But I was told "per encouner" means all visits the doctor does @ the hospital are lumped together per patient, not per how many days he saw the patient.

    In you all's experience, is this correct? Or am I getting gypped? It wasn't really spelled out in the contract I signed.

  2. #2
    Join Date
    Apr 2007
    Location
    Milwaukee WI
    Posts
    4,453

    Default My definition

    My definition matches yours. Each date of service is a separate encounter. I base this on the fact that that is how audits are done.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3

    Default

    thanks. yeah it didn't seem right to me that i get paid the same for coding 1 date of service or 10 dates of service.

  4. #4
    Join Date
    Apr 2007
    Location
    Omaha, Nebraska
    Posts
    126

    Default At Home Coding ..

    Laurabee - who do you work for? A company or an individual practice? Are they looking or needing additional help? I would like to get a little more experience coding under my belt .. I have nearly 30 years experience in medical billing and have a good understanding of how to code - just have never done it specifically. Any direction you can provide would be appreciated.

    Thank you!
    Carol
    Carolyn Kohler, CPC
    Omaha, NE

  5. #5
    Join Date
    Apr 2007
    Location
    Charleston, South Carolina
    Posts
    636

    Default

    My definition matches the one you have. You could have ten hospital days with 20 different diagnoses. Ok, maybe a bit much, but my point is just because they are an IP and have ten days, doesnt mean all the day are just the same. Each day should be a separate encounter.

    Good luck trying to resolve this!
    Machelle Morningstar, CPC, CPC-H, CEMC, COSC

  6. #6
    Join Date
    Apr 2007
    Location
    Louisville, KY
    Posts
    1,100

    Thumbs down

    I would define an "encounter" to be an episode of care. For outpatient, this is probably "per DOS". For IP, I'd say "per chart," really as the entire inpatient stay is a single episode of care.

    This probably does not help you in the way you intended. I'd advise not ever to conclude or assume anything a consulting or contract company tells you without explicit definition. Follow-up and clarification are usually required.

    Keep in mind, that this emerging format of payment (e.g., per encounter, per this or that) resembes what happened to transcriptionists several years back. They went from having base salary and a productivity and quality standard to being paid by line, by character or worse. The overall point here is that companies determining salary on these characteristics signal a bad road ahead. Clearly the professional associations and coders themselves need to do what they can to steer our salaries away from these practices. When the salaries are determined solely on production, quality really begins suffering or being pushed aside to make room for turnover.

    Just my expressed concerns. I'd advise all coders to beware of companies playing this payment game.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  7. #7
    Join Date
    Apr 2007
    Posts
    22

    Default RE:

    I code inpatient professional fee services 99221-99223, 99231-99233, 99251-99255, and 99291-99292 and the definition for an encounter for us is per DOS. If I code a pts stay from 01/01/09 thru 01/05/09 I get paid for 5 encounters;

    Tammy

  8. #8

    Default

    Thank you guys for all the responses. This was a company I used to do billing and coding for in office, but when I decided to leave a full time position there they offered me a contract job doing coding for a few of the physicians so I could still work with them. "Encounter", used as office lingo, always meant "date of service" so that's why I assumed that was the definition in that particular scenario. If it was a company I wasn't familiar with I definitely would have asked what their definition was just so that there was no misunderstanding. I'd had some trouble with my new immediate supervisor who they brought in from the outside... long story short, she told me that an encounter meant a course of hospital stay and that's how I needed to fill out my invoice, but when I asked her boss for clarification she told me that there must have been a misunderstanding and yes, "encounter" means per date of service based on how they pay. Whew!

    Sorry I can't be of any help in the job department, to the member that asked.

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