commit d1507179df16a9a6ff65bdfabe07a9a5a99df6f9
parent dba51a0fffcddf06196a5fecfd395ccf85e3b1b6
Author: C. Beau Hilton <cbeauhilton@gmail.com>
Date: Thu, 27 Aug 2020 11:03:32 -0500
memex update
Diffstat:
2 files changed, 105 insertions(+), 0 deletions(-)
diff --git a/index.md b/index.md
@@ -81,6 +81,7 @@ Vannevar Bush coined the term "memex" for a system of extending or indexing one'
- [2020-07-02-noon-conference](learn/2020-07-02-noon-conference.md)
- [2020-07-06-noon-conference](learn/2020-07-06-noon-conference.md)
- [2020-08-27-grand-rounds](learn/2020-08-27-grand-rounds.md)
+- [2020-08-27-coding-billing-yakes](learn/2020-08-27-coding-billing-yakes.md)
## blogs (good ones)
diff --git a/learn/2020-08-27-coding-billing-yakes.md b/learn/2020-08-27-coding-billing-yakes.md
@@ -0,0 +1,104 @@
+# Coding and Billing
+
+Beth Ann Yakes, who is awesome.
+
+ICD-10 Codes
+- International Classification of Diseases
+
+CPT
+- Descriptive terms and their codes to identify medical, surgical, and diagnostic services and procedures
+
+E&M service codes
+- CPT codes
+- Evaluation and Management Codes
+
+Preventive service codes
+- CPT codes for annual physical, non-medicare
+
+## E&M Coding
+
+- history
+- exam
+- Medical Decision Making (MDM) (or Time in 2021)
+
+
+Hx
+- CC and HPI
+- ROS
+- PFSH
+
+Exam
+- # organ systems (out of 12 possible)
+
+MDM
+- # and complexity of problems addressed
+- amount of data/complexity analyzed
+- risk level to pt
+
+If established patient,
+does not need to have *both* hx or exam,
+can have one or the other.
+
+Money amounts listed are for the professional fees,
+not necessarily including hospital fees, etc.
+
+Average clinic day:
+12 pts, ~2 $75, ~8 $110, ~2 $150 = ~$150 + $880 + $300 = ~$1330/day produced per provider
+
+99213 ("level 3") - ~$75
+- 1 HPI (pt is here for sore throat)
+- 1 ROS (pt denies fever or chills)
+- no PFSH
+- 2 PE (general: pt looks well, HEENT: no exudates, mild erythema)
+- 2/3 of the following
+ - address 2 minor/1 stable/1 acute uncomplicated problem
+ - review 2 pieces of data or use an independent historian (e.g. collateral from spouse)
+ - low risk tx and dx tests (e.g. OTC, simple PE maneuvers)
+
+99214 ("level 4") - ~$110 (annual physical also about this amount)
+- this is the level to keep in mind for notes, even if the MDM is level 3, just to cover your bases
+- 4 HPI (1. pt has not had CP or SOB, 2. pt has had normotension, 3. pt has been compliant with their medicines, 4. something else)
+- 2 ROS
+- 1 PFSH (at least copy and paste from old note, or click "mark as reviewed" - does NOT need to be an actual update)
+- 5 PE
+- 2/3 of the following
+ - address 2 stable/1 worsening/1 new w systemic sx/complicated hx/uncertain prognosis)
+ - review 3 pieces of data (inc ind historian), or interpret (I reviewed the CXR and do not see pna) (it's also ok to be wrong, just give good-faith effort) (lab data doesn't count, has to be radiographic or similar), or confer (does not have to be verbal conference - could be chart review of specialist's note)
+ - moderate risk tx and dx tests (rx meds - could be "cont lisinopril", social determinants limit options, elective surgery w/o major risks)
+
+99215 ("level 5") - ~$150
+- 4 HPI
+- 10 ROS
+- 2 PFSH
+- 8 PE
+- 2/3 of the following
+ - 1 severe worsening or threat-imposing new problem
+ - 2/3 of what is listed in moderate
+ - higher risk tx or dx (rx req monitoring e.g. coumadin/opioids/chemo, hospitalization, emergent surgery)
+
+
+Annual physical - ~$110
+- No CC/HPI
+- 14 ROS
+- PMH, FH, SH (c/p or "mark as reviewed" is sufficient)
+- address risk factors appropriate to age
+- multi-system PE targeted to pt
+- a/p including counseling, anticipatory guidance, risk factor mitigation
+- Identify note as "Preventive annual exam"
+- ICD-10: Z00.00
+- can add other ICD-10 codes as needed
+- billing code based on pt age
+ - 99395: 18-40
+ - 99396: 41-64
+ - 99397: >65, not medicare
+- no co-pay! (if w/in calendar year vs 365 days, depending on insurance provider)
+- tell the pt if you're not going to code the visit as annual physical, bc they'll be charged
+- can also bill for annual + problem (e.g. 99396 Z00.00 + 99213 R07.89 [CP])
+
+Coding based on counseling time
+- Lvl 3: 15min
+- Lvl 4: 25min
+- Lvl 5: 40min
+- state "I spent X minutes with the pt with >50% spent on counseling regarding Y issue. We went over A, B, C, answered questions about Q, did teachback..."
+- pick the highest billing lvl bw coding based on time or based on problem severity (e.g. lvl 3 prob, lvl 5 counseling)
+- in Jan 2021, may be able to count time spent preparing for visit and reviewing afterward, as well as in-person time
