2020-08-27-coding-billing-yakes.md (3869B)
1 # Coding and Billing 2 3 Beth Ann Yakes, who is awesome. 4 5 ICD-10 Codes 6 - International Classification of Diseases 7 8 CPT 9 - Descriptive terms and their codes to identify medical, surgical, and diagnostic services and procedures 10 11 E&M service codes 12 - CPT codes 13 - Evaluation and Management Codes 14 15 Preventive service codes 16 - CPT codes for annual physical, non-medicare 17 18 ## E&M codes 19 20 - history 21 - exam 22 - Medical Decision Making (MDM) (or Time in 2021) 23 24 25 Hx 26 - CC and HPI 27 - ROS 28 - PFSH 29 30 Exam 31 - # organ systems (out of 12 possible) 32 33 MDM 34 - # and complexity of problems addressed 35 - amount of data/complexity analyzed 36 - risk level to pt 37 38 If established patient, 39 does not need to have *both* hx or exam, 40 can have one or the other. 41 42 Money amounts listed are for the professional fees, 43 not necessarily including hospital fees, etc. 44 45 Average clinic day: 46 12 pts, ~2 $75, ~8 $110, ~2 $150 = ~$150 + $880 + $300 = ~$1330/day produced per provider 47 48 99213 ("level 3") ~$75. 49 50 - 1 HPI (pt is here for sore throat) 51 - 1 ROS (pt denies fever or chills) 52 - no PFSH 53 - 2 PE (general: pt looks well, HEENT: no exudates, mild erythema) 54 - 2/3 of the following 55 - address 2 minor/1 stable/1 acute uncomplicated problem 56 - review 2 pieces of data or use an independent historian (e.g. collateral from spouse) 57 - low risk tx and dx tests (e.g. OTC, simple PE maneuvers) 58 59 99214 ("level 4") ~$110 (annual physical also about this amount). 60 61 - this is the level to keep in mind for notes, even if the MDM is level 3, just to cover your bases 62 - 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) 63 - 2 ROS 64 - 1 PFSH (at least copy and paste from old note, or click "mark as reviewed" - does NOT need to be an actual update) 65 - 5 PE 66 - 2/3 of the following 67 - address 2 stable/1 worsening/1 new w systemic sx/complicated hx/uncertain prognosis) 68 - 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) 69 - moderate risk tx and dx tests (rx meds - could be "cont lisinopril", social determinants limit options, elective surgery w/o major risks) 70 71 99215 ("level 5") - ~$150. 72 73 - 4 HPI 74 - 10 ROS 75 - 2 PFSH 76 - 8 PE 77 - 2/3 of the following 78 - 1 severe worsening or threat-imposing new problem 79 - 2/3 of what is listed in moderate 80 - higher risk tx or dx (rx req monitoring e.g. coumadin/opioids/chemo, hospitalization, emergent surgery) 81 82 83 ## Preventive service codes 84 85 Annual physical - ~$110. 86 87 - No CC/HPI 88 - 14 ROS 89 - PMH, FH, SH (c/p or "mark as reviewed" is sufficient) 90 - address risk factors appropriate to age 91 - multi-system PE targeted to pt 92 - a/p including counseling, anticipatory guidance, risk factor mitigation 93 - Identify note as "Preventive annual exam" 94 - ICD-10: Z00.00 95 - can add other ICD-10 codes as needed 96 - billing code based on pt age 97 - 99395: 18-40 98 - 99396: 41-64 99 - 99397: >65, not medicare 100 - no co-pay! (if w/in calendar year vs 365 days, depending on insurance provider) 101 - tell the pt if you're not going to code the visit as annual physical, bc they'll be charged 102 - can also bill for annual + problem (e.g. 99396 Z00.00 + 99213 R07.89 [CP]) 103 104 Coding based on counseling time 105 106 - Lvl 3: 15min 107 - Lvl 4: 25min 108 - Lvl 5: 40min 109 - 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..." 110 - pick the highest billing lvl bw coding based on time or based on problem severity (e.g. lvl 3 prob, lvl 5 counseling) 111 - in Jan 2021, may be able to count time spent preparing for visit and reviewing afterward, as well as in-person time 112 113 last updated: 2020-08-27