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Coding Tips and Other Strategies to Increase Practice Revenue Cynthia W Denmark, FNP-BC, Wesley Primary Care-Leakesville Wesley Medical Center Disclosure of Financial Relationships Cynthia W Denmark, FNP Has no relationships with any proprietary entity producing health care goods or services consumed by or used on patients. Objectives The participant will be able to: Evaluate the financial status of the clinical practice Identify common causes of lost revenue Identify opportunities for additional sources of income Know Your Financial Status Know your largest payer Request a monthly/quarterly statement Meet with CFO quarterly Common Causes of Lost Revenue Office procedures Codes not recognized by payers Collections E&M Miscoding Common Causes of Lost Revenue: Office Procedures Destruction of Benign Lesions (Cryo) Bicillin CR 1,200,000/2mL Keratoses (17000/1; 17003/2-14) Warts (17110/1-14) $13/unit + injection fee Shave Biopsy Injection fee Venipuncture Pap Smears Common Causes of Lost Revenue ICD codes no recognized by Payers Benign Lesions Fatigue Vitamin D Collections E&M miscoding Seek Additional Revenue Contract with Businesses See Pts in LTCF House Calls Group Visits (SMA) Case Study #1 Established pt cc: sore throat HPI: 23 yo F c/o sore throat “hurts to swallow”, fever>101. The problem started suddenly yesterday. She took ibuprofen last night & this morning. Nothing relieves the pain. Her child is currently taking amoxicillin for strep throat. Case Study #1 SH: quit smoking 2 yrs ago ROS: no ear pain, no sinus pressure or drg, no cough or chest tightness/pain Exam: BP 112.68 HR 72 RR 18 T 100.8 Eyes: non-injected, no drg ENMT: TMs clear, no nasal drg, Tonsils enlarged/erythematous with exudates Neck: cervical lymph node tenderness Lungs: BBS CTA CV: RRR, no murmur GI: no splenomegaly; abd soft, non-tender Skin: no rash Case Study #1 Labs: rapid strep (positive) Impression/Plan: Streptococcal Sore Throat Bicillin CR 12 units IM now Alternate Tylenol & Ibuprofen q 3 hrs prn fever/pain Chloroseptic lozenges for sore throat Discard toothbrush RTC if symptoms persist/worsen Case Study #2 cc: f/u DM, dyslipidemia, HTN HPI: 68 yr M presents for refills and f/u. FBG was 118 this a.m. His previous TG was slightly elevated at 162 and has since been taking 2000mg fish oil daily along with his lovastatin. His BP is controlled by diet & lisinopril 10mg daily. Case Study#2 PFSH: reviewed with no changes ROS: denies SOB, chest pain Exam: BP 130/78 HR 72 RR 20 T 98.8 BMI 29 Overweight; normal affect; BBS CTA; RRR; no murmur; Impression/Plan DM, Dyslipidemia, HTN Continue current medications RTC in 30 days for labs (A1c, Lipids, CMP) E&M Coding (Est. Patient) CPT 99212 99213 99214 99215 HPI ROS PFSH 1 1 1 4 (3 chronics) 4 (3 chronics) 2 1 10 2 Exam 1 2 5 8 MDM SF Low Mod High Time 10 min 15 min 25 min 40 min E&M Coding (New Patient) CPT 99201 99202 99203 99204 99205 HPI ROS PFSH Exam 1 1 1 1 2 4 2 1 5 4 10 3 8 4 10 3 8 MDM SF SF Low Mod High Time 10 20 30 45 80 Pearls for Documenting Have Nurse/MA document history & ROS (You must document that you reviewed) Risk: moderate risk=level 4 visit Prescription drugs 1 chronic illness w/ progression or SE of tx 2+ stable illnesses Undiagnosed new problem Pearls for Documenting Document ALL exam elements. There are 7 elements to document PRIOR to the “examination” General appearance Eyes: injected, no drg ENT: hearing intact MSK: normal gait/limp Psych: normal affect, depressed, agitated Skin: no rash on face/arms Immunologic: NKDA (use of PMH or PE) Pearls for Documenting Avoid “all others negative” for ROS. State the # of systems reviewed. Avoid “non contributory” or “not significant to current illness” for PFSH. Recommend “was reviewed and is negative”