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Guidelines

  1. #1
    Default Guidelines
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    Just curious, new CPC here. How do other outpatient practice coders do E/M levels. Do you use what doctor puts or redo every level? Is there a guideline at each employer of what your responsibilities are? compliance code or something to go by that says yes you check all levels or no you don't and exactly what your responsbilities as a Certified Professional Coder are? Thanks for input.

    This is in a multi-physician outpatient organization.
    Last edited by pamfran; 03-08-2010 at 09:01 PM. Reason: adding more information

  2. #2
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    Your facility is required to have a set of guidelines specific to the facility to use to assess thr facility visit levels. You do not use what the physician used. If your level matches the physician's it should be coincidence only. Also your facility must have designated the responsibility of visit level assignment and if that is the coder then great but you need the facilities guidelines to do that.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    At our practice, the doctor chooses the level of service. I do spot audits and random audits to make sure that the guidelines are being met. I re-train the physicians when I find that they are not coding or documenting correctly. I wish that I had time to audit every single charge before it goes out, but there is no way I can do that due to the volume.
    Walker Bachman, CPC, CPPM

  4. #4
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    But in the facility there must be someone employed by the facility to assign the facility E&M level not the physician. Usually it is a unit clerk but it works so much better if it is done by the coding department.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    Debra, Please explain. I think this is something we are not doing. Who says the facility is required to have guidelines and why can't a physician assign the E&M level? I review 10 charts per provider every 3 months. I use the CMS guidelines, but I don't know of any guidelines our facility has and our doctors with the help of NextGen choose the level. Thank You, Cathy

  6. #6
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    The facility level is assigned by the facility because it represents the utilization of the facility's resources whereas your physician E&M represents the physician skill, time, and expertise. The 95 and 97 guidelines are for the capture of the physician level. The facility does not have standard guidelines, they have been charges with creating their own. The physician cannot assign the facility level because they are not "in tune" with the facility resources consumed,.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    Oh my, the more I learn, the more I have to learn. I think the reason I decided on coding was for the constant change so I would not be bored. LOL Thanks, Cathy

  8. #8
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    Not a problemthat is why I love my job! In the facility I worked in we used a point system for our facility level and a lot of other facilities use points as well. In other words the nurse takes vital signs, she is a facility resourse so we gave 5 points. To take a patient to the lab or xray uses a patient transported so we charge 5 points for each type of lab (chemistry, hematology) and xray. We change a dressing so we charge 5 points for small, 10 for intermediate and 15 for a large dressing change. Basically if there is no CPT code for it and we used a resource we gave it points. Then our point spread is set up for anything less than 5 points is not chargable, 5-10 is a level 1, 11-10 is a level 2 and so on. If our level matches the physicians then it is pur coincidence. There is criteria that has to be followed when setting up the facility guidelines, like the must be objective, applied to all patients, acturately meets the acuity level of the patient, and so on. Good luck and have fun!

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default andyw
    I want to make sure all of you are not mixing the rules for E&M Outpatient Facility Coding and those for provider (MD, NPP or PA) Office (non-facility) E&M Coding. In the Office (non-facility) setting the provider's work is the only work that can be coded and billed for. The provider is held legally responsible by CMS for all billed services and should chose the level of service unless an agreement has been reached with coding and or billing staff to allow E&M levels of service to be chosen based on provider documentation for visit.
    I hope I am not belaboring an already understood point, if so my apologies.
    Andy

    A Worthington MD, CPC

  10. #10
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    Yes, this is exactly what I need Andy. Thank you. There is a big difference between office non facility coding and hospital or facility coding. So I think what you are saying is that if we are changing codes to match documentation that this should be in some type of guidelines agreed on by providers and Administration?

    Pam

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