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I just finished school!

  1. #1
    Default I just finished school!
    Medical Coding Books
    Hi everyone,
    I'm as new as they come! Not even certified yet, but will take the test this summer. So glad to be finished with studying non-stop! I'm doing my residency at my primary care physician's office. His practice is a good one-really caring people. The person I'm replacing is not a coder and I discovered that the office was not billing Medicare for theraputic injections. I discovered this by accident, and I started wondering how else I can do a good job and help the office maximize their income. Example, one of the doctors charted the reason for encounter "Bereavement". That really was not the case. The lady needed something for depression following her husband's sudden death and she received counseling by the doctor for about 30 minutes about how to cope for now and ideas for the future. Though we cannot bill for psychological care, I think Bereavement is an incorrect chart comment. The woman came for counseling and meds for the effects of her loss. I know there are valid codes for counseling on family matters, tobacco cessation, weight management, etc. Is this valid for an encounter for counseling? I cannot ask the doctor to change her charting, but I wonder if the office is missing out due to improper charting. Maybe if the doctors were informed about counseling guidelines they would chart the encounter differently. I'm not trying to put words in anyone's mouth, but I want to be efficient and as a coder I want them to be able to bill for all allowable charges. Where can I get some tips on where to search for more possible areas of improvement?
    Thanks!
    Flycliffyboo

  2. #2
    Default
    Congrats for finishing school!!!!

    I suggest you go thru the CPT book to locate some information on descriptions of the codes, there are also the carrier websites that you could check, like your local medicare, bls etc....


    One thing to remember is if you are going to speak with the dr's about anything of that nature... have your reference (s) available to show them, they love to see it "documented".

    Good luck



    Quote Originally Posted by flycliffyboo View Post
    Hi everyone,
    I'm as new as they come! Not even certified yet, but will take the test this summer. So glad to be finished with studying non-stop! I'm doing my residency at my primary care physician's office. His practice is a good one-really caring people. The person I'm replacing is not a coder and I discovered that the office was not billing Medicare for theraputic injections. I discovered this by accident, and I started wondering how else I can do a good job and help the office maximize their income. Example, one of the doctors charted the reason for encounter "Bereavement". That really was not the case. The lady needed something for depression following her husband's sudden death and she received counseling by the doctor for about 30 minutes about how to cope for now and ideas for the future. Though we cannot bill for psychological care, I think Bereavement is an incorrect chart comment. The woman came for counseling and meds for the effects of her loss. I know there are valid codes for counseling on family matters, tobacco cessation, weight management, etc. Is this valid for an encounter for counseling? I cannot ask the doctor to change her charting, but I wonder if the office is missing out due to improper charting. Maybe if the doctors were informed about counseling guidelines they would chart the encounter differently. I'm not trying to put words in anyone's mouth, but I want to be efficient and as a coder I want them to be able to bill for all allowable charges. Where can I get some tips on where to search for more possible areas of improvement?
    Thanks!
    Flycliffyboo
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. Default
    Congratulations! Keep up the good work. Sounds to me like you're on the right track.

    ~L
    CPC, CGSC, COSC

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