SlideShare une entreprise Scribd logo
1  sur  18
Practice Essentials for Physicians
 For E&M Coding, Understand Current
 Challenges
 Controversies
 Trends
 Guidelines do not define criteria for
 Number of diagnosis or treatment options
 Amount and complexity of data reviewed
 Each Medicare carrier has discretion in this
area
 Fortunately, most now use the same criteria
 When comparing 136 certified professional
coders..Type of
encounter
Undercoded Coded
Correctly
Overcoded
Established
Patient
24% 59% 17%
New Patient 8% 59% 33%
This study compared E&M coding for 6 sample patient encounters by
136 certified coders with an average of 10 years of coding
experience. The coding level with the highest level of agreement was
considered the correct level. Overall agreement on coding level was
59%
 When compared to expert coders, FP
physicians..Type of
encounter
Undercoded Coded
Correctly
Overcoded
Established
Patient
33% 51% 16%
New Patient 1% 17% 82%
This study compared E&M coding for 6 sample patient encounters by
198 FP physicians and professional coders. Coding by professional
coders was considered to be accurate for the purposes of this study.
J Am Board Fam Pract 2001;14:184-92
Undercoding is a major problem
 An audit of 351 Family Practice notes
showed…
Undercoded
33%
Based on audit of documentation
Shows rate of actual undercoding.
South Med J. 2010 Apr;103(4):316-22
Worse if just considering MDM
 An audit of 351 Family Practice notes
showed…
Undercoded
50%
Based on audit of MDM documentatio
Approximates what could have been
coded if properly documented in
History + Exam sections.South Med J. 2010 Apr;103(4):316-22
Worse if considering presenting
problem(s)
 An audit of 351 Family Practice notes
showed…
Undercoded
80%
Based on audit of presenting problem
Approximates what could have been
coded if properly documented for
History + Exam + MDM
South Med J. 2010 Apr;103(4):316-22
Example – Hospital Admission
Initial
Inpatient
Evaluation
CPT Code
Medicare
Allowable
Charge
RVUs
Level 3 99223 $204 3.86
Level 2 99222 $138 2.61
Level 1 99221 $102 1.92
2014 Medicare Physician Fee Schedule, National Payment Amount, Accessed
Undercoding by just one level reduces the Medicare Allowable Charge by 26-33%
Medical Documentation Challenges, Controversies, and Trends
0%
10%
20%
30%
40%
50%
60%
99211 99212 99213 99214 99215
2001
2002
2003
2004
2005
2006
2007
2008
2009
Coding Trends of Medicare Evaluation and Management Services OEI-04-10-00180
0%
10%
20%
30%
40%
50%
60%
99211 99212 99213 99214 99215
2001
2002
2003
2004
2005
2006
2007
2008
2009
Coding Trends of Medicare Evaluation and Management Services OEI-04-10-00180
Moderate
MDM
0%
10%
20%
30%
40%
50%
60%
70%
99231 99232 99233
2001
2002
2003
2004
2005
2006
2007
2008
2009
Coding Trends of Medicare Evaluation and Management Services OEI-04-10-00180
0%
10%
20%
30%
40%
50%
60%
70%
99231 99232 99233
2001
2002
2003
2004
2005
2006
2007
2008
2009
Coding Trends of Medicare Evaluation and Management Services OEI-04-10-00180
Moderate
MDM
 Set level with MDM
 Document History/Exam to support level
 Consider
 E&M coding software
 Documentation templates
Medical Documentation Challenges, Controversies, and Trends
Model used by 75% of practices in 2012/2013 Merritt Hawkins Survey
 Complex Rules
 Consider
 E&M Coding Software
 Documentation Templates
 Mastery of the rules relevant to your practice is
essential for financial success

Contenu connexe

Tendances

Global regenerative medicines market (technology, application and geography) ...
Global regenerative medicines market (technology, application and geography) ...Global regenerative medicines market (technology, application and geography) ...
Global regenerative medicines market (technology, application and geography) ...Allied Market Research
 
HawkPartners Perspective on Payer Research
HawkPartners Perspective on Payer ResearchHawkPartners Perspective on Payer Research
HawkPartners Perspective on Payer ResearchHawkPartners
 
Rx15 tpp wed_300_1_paduda-white_2hanna
Rx15 tpp wed_300_1_paduda-white_2hannaRx15 tpp wed_300_1_paduda-white_2hanna
Rx15 tpp wed_300_1_paduda-white_2hannaOPUNITE
 
Rolf Panel Ely Jin
Rolf Panel Ely JinRolf Panel Ely Jin
Rolf Panel Ely JinIDS
 
Using Technology to Increase Medication Adherence
Using Technology to Increase Medication AdherenceUsing Technology to Increase Medication Adherence
Using Technology to Increase Medication AdherenceTimothy Aungst, Pharm.D.
 

Tendances (7)

Global regenerative medicines market (technology, application and geography) ...
Global regenerative medicines market (technology, application and geography) ...Global regenerative medicines market (technology, application and geography) ...
Global regenerative medicines market (technology, application and geography) ...
 
HawkPartners Perspective on Payer Research
HawkPartners Perspective on Payer ResearchHawkPartners Perspective on Payer Research
HawkPartners Perspective on Payer Research
 
Rx15 tpp wed_300_1_paduda-white_2hanna
Rx15 tpp wed_300_1_paduda-white_2hannaRx15 tpp wed_300_1_paduda-white_2hanna
Rx15 tpp wed_300_1_paduda-white_2hanna
 
Jamila Fraud & Abuse
Jamila Fraud & AbuseJamila Fraud & Abuse
Jamila Fraud & Abuse
 
Rolf Panel Ely Jin
Rolf Panel Ely JinRolf Panel Ely Jin
Rolf Panel Ely Jin
 
Using Technology to Increase Medication Adherence
Using Technology to Increase Medication AdherenceUsing Technology to Increase Medication Adherence
Using Technology to Increase Medication Adherence
 
Third party Financial Issues
Third party Financial IssuesThird party Financial Issues
Third party Financial Issues
 

En vedette

URISA, the Geospatial Revolution, and the GIS Management Institute
URISA, the Geospatial Revolution, and the GIS Management InstituteURISA, the Geospatial Revolution, and the GIS Management Institute
URISA, the Geospatial Revolution, and the GIS Management InstituteGreg Babinski
 
AAA_OFFICIAL MENU
AAA_OFFICIAL MENUAAA_OFFICIAL MENU
AAA_OFFICIAL MENUSams Bar
 
Methodology Perspective and Narrative
Methodology Perspective and NarrativeMethodology Perspective and Narrative
Methodology Perspective and NarrativeLarry Dalton
 
Antihipertensi ekstrak daun mimba
Antihipertensi ekstrak daun mimbaAntihipertensi ekstrak daun mimba
Antihipertensi ekstrak daun mimbaNurul Amelia
 
AMAR - INFORME do 4º Trimestre de 2016 - páginas 01 à 08
AMAR - INFORME do 4º Trimestre de 2016 - páginas 01 à 08AMAR - INFORME do 4º Trimestre de 2016 - páginas 01 à 08
AMAR - INFORME do 4º Trimestre de 2016 - páginas 01 à 08Amar Jardim Oceânico
 
数奇屋もしくは、檻
数奇屋もしくは、檻数奇屋もしくは、檻
数奇屋もしくは、檻Yuta Muraguchi
 
Analisis irene
Analisis ireneAnalisis irene
Analisis ireneire8
 
A relevância da participação em centros acadêmicos para a formação complement...
A relevância da participação em centros acadêmicos para a formação complement...A relevância da participação em centros acadêmicos para a formação complement...
A relevância da participação em centros acadêmicos para a formação complement...Ronildo Oliveira
 
Mock feature article
Mock feature articleMock feature article
Mock feature articlesean_lismore
 
How are physicians paid?
How are physicians paid?How are physicians paid?
How are physicians paid?Robert Robinson
 
Google - Kepentingan Dan Kegunaan
Google - Kepentingan Dan KegunaanGoogle - Kepentingan Dan Kegunaan
Google - Kepentingan Dan KegunaanBelajar Buatblog
 
ThunderX ARMV8 Servers: Disruption and Innovation in the Server Market
ThunderX ARMV8 Servers: Disruption and Innovation in the Server MarketThunderX ARMV8 Servers: Disruption and Innovation in the Server Market
ThunderX ARMV8 Servers: Disruption and Innovation in the Server MarketRed_Hat_Storage
 
Comportamiento organizacional
Comportamiento organizacionalComportamiento organizacional
Comportamiento organizacionalCarlos Ramirez
 
Introduction to Medical records and Documentation revised 01-13
Introduction to Medical records and Documentation revised 01-13Introduction to Medical records and Documentation revised 01-13
Introduction to Medical records and Documentation revised 01-13kbpennington
 

En vedette (20)

Allnewgovtjobs
AllnewgovtjobsAllnewgovtjobs
Allnewgovtjobs
 
URISA, the Geospatial Revolution, and the GIS Management Institute
URISA, the Geospatial Revolution, and the GIS Management InstituteURISA, the Geospatial Revolution, and the GIS Management Institute
URISA, the Geospatial Revolution, and the GIS Management Institute
 
AAA_OFFICIAL MENU
AAA_OFFICIAL MENUAAA_OFFICIAL MENU
AAA_OFFICIAL MENU
 
Methodology Perspective and Narrative
Methodology Perspective and NarrativeMethodology Perspective and Narrative
Methodology Perspective and Narrative
 
Antihipertensi ekstrak daun mimba
Antihipertensi ekstrak daun mimbaAntihipertensi ekstrak daun mimba
Antihipertensi ekstrak daun mimba
 
AMAR - INFORME do 4º Trimestre de 2016 - páginas 01 à 08
AMAR - INFORME do 4º Trimestre de 2016 - páginas 01 à 08AMAR - INFORME do 4º Trimestre de 2016 - páginas 01 à 08
AMAR - INFORME do 4º Trimestre de 2016 - páginas 01 à 08
 
数奇屋もしくは、檻
数奇屋もしくは、檻数奇屋もしくは、檻
数奇屋もしくは、檻
 
Analisis irene
Analisis ireneAnalisis irene
Analisis irene
 
Palillos
PalillosPalillos
Palillos
 
Waya Carlos Night
Waya Carlos NightWaya Carlos Night
Waya Carlos Night
 
A relevância da participação em centros acadêmicos para a formação complement...
A relevância da participação em centros acadêmicos para a formação complement...A relevância da participação em centros acadêmicos para a formação complement...
A relevância da participação em centros acadêmicos para a formação complement...
 
Mock feature article
Mock feature articleMock feature article
Mock feature article
 
trabajo y energia
trabajo y energiatrabajo y energia
trabajo y energia
 
How are physicians paid?
How are physicians paid?How are physicians paid?
How are physicians paid?
 
September16
September16September16
September16
 
Google - Kepentingan Dan Kegunaan
Google - Kepentingan Dan KegunaanGoogle - Kepentingan Dan Kegunaan
Google - Kepentingan Dan Kegunaan
 
ThunderX ARMV8 Servers: Disruption and Innovation in the Server Market
ThunderX ARMV8 Servers: Disruption and Innovation in the Server MarketThunderX ARMV8 Servers: Disruption and Innovation in the Server Market
ThunderX ARMV8 Servers: Disruption and Innovation in the Server Market
 
WEB会社説明会のご提案
WEB会社説明会のご提案WEB会社説明会のご提案
WEB会社説明会のご提案
 
Comportamiento organizacional
Comportamiento organizacionalComportamiento organizacional
Comportamiento organizacional
 
Introduction to Medical records and Documentation revised 01-13
Introduction to Medical records and Documentation revised 01-13Introduction to Medical records and Documentation revised 01-13
Introduction to Medical records and Documentation revised 01-13
 

Similaire à Medical Documentation Challenges, Controversies, and Trends

Continuous Quality Monitoring Maximizes ICD-10 Proficiency
Continuous Quality Monitoring Maximizes ICD-10 Proficiency Continuous Quality Monitoring Maximizes ICD-10 Proficiency
Continuous Quality Monitoring Maximizes ICD-10 Proficiency Amphion Medical Solutions
 
Practice Coding: Market Drivers and Demand Forecast
Practice Coding: Market Drivers and Demand Forecast Practice Coding: Market Drivers and Demand Forecast
Practice Coding: Market Drivers and Demand Forecast mckessonrms
 
Practicalandsuccinctsolutionstocoding 140519132624-phpapp02
Practicalandsuccinctsolutionstocoding 140519132624-phpapp02Practicalandsuccinctsolutionstocoding 140519132624-phpapp02
Practicalandsuccinctsolutionstocoding 140519132624-phpapp02SelectData
 
Practical and Succinct Solutions to Coding - Select Data, Inc.
Practical and Succinct Solutions to Coding - Select Data, Inc. Practical and Succinct Solutions to Coding - Select Data, Inc.
Practical and Succinct Solutions to Coding - Select Data, Inc. RachelBuckleySelect
 
diagnosis code confusion leads to medical billing errors
diagnosis code confusion leads to medical billing errorsdiagnosis code confusion leads to medical billing errors
diagnosis code confusion leads to medical billing errorsMichel Desuza
 
Coding For RCM Managers
Coding For RCM ManagersCoding For RCM Managers
Coding For RCM Managersblabar
 
Are denials and payer audits still impacting your bottom line?
Are denials and payer audits still impacting your bottom line?Are denials and payer audits still impacting your bottom line?
Are denials and payer audits still impacting your bottom line?Matt Moneypenny
 
Coding NotesImproving Diagnosis By Jacquie zegan, CCS, w.docx
Coding NotesImproving Diagnosis By Jacquie zegan, CCS, w.docxCoding NotesImproving Diagnosis By Jacquie zegan, CCS, w.docx
Coding NotesImproving Diagnosis By Jacquie zegan, CCS, w.docxmary772
 
2 Best Practices to Improve Emergency Department Coding
2 Best Practices to Improve Emergency Department Coding2 Best Practices to Improve Emergency Department Coding
2 Best Practices to Improve Emergency Department CodingManish Jain
 
ACDIS OP-CDI 2011
ACDIS OP-CDI 2011ACDIS OP-CDI 2011
ACDIS OP-CDI 2011CZNANIEC
 
Perpetual Care Hospital Essay
Perpetual Care Hospital EssayPerpetual Care Hospital Essay
Perpetual Care Hospital EssayCrystal Williams
 
2014 December 16 - eHI Survey Summary - BLUE AND GRAY LAY OUT BY WARREN - FINAL
2014 December 16 - eHI Survey Summary - BLUE AND GRAY LAY OUT BY WARREN - FINAL2014 December 16 - eHI Survey Summary - BLUE AND GRAY LAY OUT BY WARREN - FINAL
2014 December 16 - eHI Survey Summary - BLUE AND GRAY LAY OUT BY WARREN - FINALCarrie Bauman
 
Research Report - Insights into Revenue Cycle Management
Research Report - Insights into Revenue Cycle ManagementResearch Report - Insights into Revenue Cycle Management
Research Report - Insights into Revenue Cycle ManagementBESLER
 
Aetna icd 10 collaborative testing Nov 2014
Aetna icd 10 collaborative testing Nov 2014Aetna icd 10 collaborative testing Nov 2014
Aetna icd 10 collaborative testing Nov 2014Florida Blue
 
Medical Billing And Coding And Billing
Medical Billing And Coding And BillingMedical Billing And Coding And Billing
Medical Billing And Coding And BillingHeather Love
 

Similaire à Medical Documentation Challenges, Controversies, and Trends (20)

The DRG System
The DRG SystemThe DRG System
The DRG System
 
Continuous Quality Monitoring Maximizes ICD-10 Proficiency
Continuous Quality Monitoring Maximizes ICD-10 Proficiency Continuous Quality Monitoring Maximizes ICD-10 Proficiency
Continuous Quality Monitoring Maximizes ICD-10 Proficiency
 
Practice Coding: Market Drivers and Demand Forecast
Practice Coding: Market Drivers and Demand Forecast Practice Coding: Market Drivers and Demand Forecast
Practice Coding: Market Drivers and Demand Forecast
 
Practicalandsuccinctsolutionstocoding 140519132624-phpapp02
Practicalandsuccinctsolutionstocoding 140519132624-phpapp02Practicalandsuccinctsolutionstocoding 140519132624-phpapp02
Practicalandsuccinctsolutionstocoding 140519132624-phpapp02
 
Practical and Succinct Solutions to Coding - Select Data, Inc.
Practical and Succinct Solutions to Coding - Select Data, Inc. Practical and Succinct Solutions to Coding - Select Data, Inc.
Practical and Succinct Solutions to Coding - Select Data, Inc.
 
Medical Coding 101
Medical Coding 101Medical Coding 101
Medical Coding 101
 
diagnosis code confusion leads to medical billing errors
diagnosis code confusion leads to medical billing errorsdiagnosis code confusion leads to medical billing errors
diagnosis code confusion leads to medical billing errors
 
Coding For RCM Managers
Coding For RCM ManagersCoding For RCM Managers
Coding For RCM Managers
 
Are denials and payer audits still impacting your bottom line?
Are denials and payer audits still impacting your bottom line?Are denials and payer audits still impacting your bottom line?
Are denials and payer audits still impacting your bottom line?
 
Coding NotesImproving Diagnosis By Jacquie zegan, CCS, w.docx
Coding NotesImproving Diagnosis By Jacquie zegan, CCS, w.docxCoding NotesImproving Diagnosis By Jacquie zegan, CCS, w.docx
Coding NotesImproving Diagnosis By Jacquie zegan, CCS, w.docx
 
2 Best Practices to Improve Emergency Department Coding
2 Best Practices to Improve Emergency Department Coding2 Best Practices to Improve Emergency Department Coding
2 Best Practices to Improve Emergency Department Coding
 
ACDIS OP-CDI 2011
ACDIS OP-CDI 2011ACDIS OP-CDI 2011
ACDIS OP-CDI 2011
 
Perpetual Care Hospital Essay
Perpetual Care Hospital EssayPerpetual Care Hospital Essay
Perpetual Care Hospital Essay
 
Cdm
CdmCdm
Cdm
 
2014 December 16 - eHI Survey Summary - BLUE AND GRAY LAY OUT BY WARREN - FINAL
2014 December 16 - eHI Survey Summary - BLUE AND GRAY LAY OUT BY WARREN - FINAL2014 December 16 - eHI Survey Summary - BLUE AND GRAY LAY OUT BY WARREN - FINAL
2014 December 16 - eHI Survey Summary - BLUE AND GRAY LAY OUT BY WARREN - FINAL
 
Research Report - Insights into Revenue Cycle Management
Research Report - Insights into Revenue Cycle ManagementResearch Report - Insights into Revenue Cycle Management
Research Report - Insights into Revenue Cycle Management
 
Aetna icd 10 collaborative testing Nov 2014
Aetna icd 10 collaborative testing Nov 2014Aetna icd 10 collaborative testing Nov 2014
Aetna icd 10 collaborative testing Nov 2014
 
Medical Billing And Coding And Billing
Medical Billing And Coding And BillingMedical Billing And Coding And Billing
Medical Billing And Coding And Billing
 
DHUG 2017 - Access Integrity
DHUG 2017 - Access IntegrityDHUG 2017 - Access Integrity
DHUG 2017 - Access Integrity
 
Pmcf data quality challenges & best practices
Pmcf data quality challenges & best practicesPmcf data quality challenges & best practices
Pmcf data quality challenges & best practices
 

Plus de Robert Robinson

Perioperative medicine - Internal Medicine Board Review Conference
Perioperative medicine - Internal Medicine Board Review ConferencePerioperative medicine - Internal Medicine Board Review Conference
Perioperative medicine - Internal Medicine Board Review ConferenceRobert Robinson
 
Physician Employment Contracts for Residents
Physician Employment Contracts for ResidentsPhysician Employment Contracts for Residents
Physician Employment Contracts for ResidentsRobert Robinson
 
Publishing Quality Improvement (QI) projects
Publishing Quality Improvement (QI) projectsPublishing Quality Improvement (QI) projects
Publishing Quality Improvement (QI) projectsRobert Robinson
 
Metabolic encephalopathy diagnosis and management
Metabolic encephalopathy diagnosis and managementMetabolic encephalopathy diagnosis and management
Metabolic encephalopathy diagnosis and managementRobert Robinson
 
Hospital Discharge Process Overview
Hospital Discharge Process OverviewHospital Discharge Process Overview
Hospital Discharge Process OverviewRobert Robinson
 
The impact of Scribes on EHR users
The impact of Scribes on EHR usersThe impact of Scribes on EHR users
The impact of Scribes on EHR usersRobert Robinson
 
Acute Pancreatitis - Diagnosis and Management
Acute Pancreatitis - Diagnosis and ManagementAcute Pancreatitis - Diagnosis and Management
Acute Pancreatitis - Diagnosis and ManagementRobert Robinson
 
Medical Documentation for E&M Coding
Medical Documentation for E&M CodingMedical Documentation for E&M Coding
Medical Documentation for E&M CodingRobert Robinson
 
Physician Revenue - Getting paid for the work you do
Physician Revenue - Getting paid for the work you doPhysician Revenue - Getting paid for the work you do
Physician Revenue - Getting paid for the work you doRobert Robinson
 
Healthcare is a Business
Healthcare is a BusinessHealthcare is a Business
Healthcare is a BusinessRobert Robinson
 

Plus de Robert Robinson (10)

Perioperative medicine - Internal Medicine Board Review Conference
Perioperative medicine - Internal Medicine Board Review ConferencePerioperative medicine - Internal Medicine Board Review Conference
Perioperative medicine - Internal Medicine Board Review Conference
 
Physician Employment Contracts for Residents
Physician Employment Contracts for ResidentsPhysician Employment Contracts for Residents
Physician Employment Contracts for Residents
 
Publishing Quality Improvement (QI) projects
Publishing Quality Improvement (QI) projectsPublishing Quality Improvement (QI) projects
Publishing Quality Improvement (QI) projects
 
Metabolic encephalopathy diagnosis and management
Metabolic encephalopathy diagnosis and managementMetabolic encephalopathy diagnosis and management
Metabolic encephalopathy diagnosis and management
 
Hospital Discharge Process Overview
Hospital Discharge Process OverviewHospital Discharge Process Overview
Hospital Discharge Process Overview
 
The impact of Scribes on EHR users
The impact of Scribes on EHR usersThe impact of Scribes on EHR users
The impact of Scribes on EHR users
 
Acute Pancreatitis - Diagnosis and Management
Acute Pancreatitis - Diagnosis and ManagementAcute Pancreatitis - Diagnosis and Management
Acute Pancreatitis - Diagnosis and Management
 
Medical Documentation for E&M Coding
Medical Documentation for E&M CodingMedical Documentation for E&M Coding
Medical Documentation for E&M Coding
 
Physician Revenue - Getting paid for the work you do
Physician Revenue - Getting paid for the work you doPhysician Revenue - Getting paid for the work you do
Physician Revenue - Getting paid for the work you do
 
Healthcare is a Business
Healthcare is a BusinessHealthcare is a Business
Healthcare is a Business
 

Dernier

Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfAnatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfhezamzaki1
 
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHYCECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHYRMC
 
Assisted Living Care Residency - PapayaCare
Assisted Living Care Residency - PapayaCareAssisted Living Care Residency - PapayaCare
Assisted Living Care Residency - PapayaCareratilalthakkar704
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborHealth Catalyst
 
Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)bishwabandhuniraula
 
Eating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports PsychologyEating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports Psychologyshantisphysio
 
person with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxperson with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxMUKESH PADMANABHAN
 
Health literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxHealth literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxPamela McKinney
 
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdfDolisha Warbi
 
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....sharyurangari111
 
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete HealthLiving Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete HealthLyons Health
 
NEONATAL RESPIRATORY CARE FROM A PHYSIO POV.pptx
NEONATAL RESPIRATORY CARE FROM A PHYSIO POV.pptxNEONATAL RESPIRATORY CARE FROM A PHYSIO POV.pptx
NEONATAL RESPIRATORY CARE FROM A PHYSIO POV.pptxHanineHassan2
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadAlex Clapson
 
Understanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common LocationsUnderstanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common LocationsNeha Sharma
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementIris Thiele Isip-Tan
 
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
LARYNGEAL CANCER.pptx  Prepared by Neha KewatLARYNGEAL CANCER.pptx  Prepared by Neha Kewat
LARYNGEAL CANCER.pptx Prepared by Neha KewatNehaKewat
 
21 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 202421 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 2024Traumasoft LLC
 
EYE CANCER.pptx prepared by Neha kewat digital learning
EYE CANCER.pptx prepared by  Neha kewat digital learningEYE CANCER.pptx prepared by  Neha kewat digital learning
EYE CANCER.pptx prepared by Neha kewat digital learningNehaKewat
 

Dernier (20)

Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfAnatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
 
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHYCECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
 
Assisted Living Care Residency - PapayaCare
Assisted Living Care Residency - PapayaCareAssisted Living Care Residency - PapayaCare
Assisted Living Care Residency - PapayaCare
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and Labor
 
Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)
 
Annual Training
Annual TrainingAnnual Training
Annual Training
 
Eating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports PsychologyEating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports Psychology
 
person with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxperson with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptx
 
Health literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxHealth literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptx
 
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
 
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
 
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete HealthLiving Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
 
SCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATIONSCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATION
 
NEONATAL RESPIRATORY CARE FROM A PHYSIO POV.pptx
NEONATAL RESPIRATORY CARE FROM A PHYSIO POV.pptxNEONATAL RESPIRATORY CARE FROM A PHYSIO POV.pptx
NEONATAL RESPIRATORY CARE FROM A PHYSIO POV.pptx
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion instead
 
Understanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common LocationsUnderstanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common Locations
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes Management
 
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
LARYNGEAL CANCER.pptx  Prepared by Neha KewatLARYNGEAL CANCER.pptx  Prepared by Neha Kewat
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
 
21 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 202421 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 2024
 
EYE CANCER.pptx prepared by Neha kewat digital learning
EYE CANCER.pptx prepared by  Neha kewat digital learningEYE CANCER.pptx prepared by  Neha kewat digital learning
EYE CANCER.pptx prepared by Neha kewat digital learning
 

Medical Documentation Challenges, Controversies, and Trends

  • 2.  For E&M Coding, Understand Current  Challenges  Controversies  Trends
  • 3.  Guidelines do not define criteria for  Number of diagnosis or treatment options  Amount and complexity of data reviewed  Each Medicare carrier has discretion in this area  Fortunately, most now use the same criteria
  • 4.  When comparing 136 certified professional coders..Type of encounter Undercoded Coded Correctly Overcoded Established Patient 24% 59% 17% New Patient 8% 59% 33% This study compared E&M coding for 6 sample patient encounters by 136 certified coders with an average of 10 years of coding experience. The coding level with the highest level of agreement was considered the correct level. Overall agreement on coding level was 59%
  • 5.  When compared to expert coders, FP physicians..Type of encounter Undercoded Coded Correctly Overcoded Established Patient 33% 51% 16% New Patient 1% 17% 82% This study compared E&M coding for 6 sample patient encounters by 198 FP physicians and professional coders. Coding by professional coders was considered to be accurate for the purposes of this study. J Am Board Fam Pract 2001;14:184-92
  • 6. Undercoding is a major problem  An audit of 351 Family Practice notes showed… Undercoded 33% Based on audit of documentation Shows rate of actual undercoding. South Med J. 2010 Apr;103(4):316-22
  • 7. Worse if just considering MDM  An audit of 351 Family Practice notes showed… Undercoded 50% Based on audit of MDM documentatio Approximates what could have been coded if properly documented in History + Exam sections.South Med J. 2010 Apr;103(4):316-22
  • 8. Worse if considering presenting problem(s)  An audit of 351 Family Practice notes showed… Undercoded 80% Based on audit of presenting problem Approximates what could have been coded if properly documented for History + Exam + MDM South Med J. 2010 Apr;103(4):316-22
  • 9. Example – Hospital Admission Initial Inpatient Evaluation CPT Code Medicare Allowable Charge RVUs Level 3 99223 $204 3.86 Level 2 99222 $138 2.61 Level 1 99221 $102 1.92 2014 Medicare Physician Fee Schedule, National Payment Amount, Accessed Undercoding by just one level reduces the Medicare Allowable Charge by 26-33%
  • 11. 0% 10% 20% 30% 40% 50% 60% 99211 99212 99213 99214 99215 2001 2002 2003 2004 2005 2006 2007 2008 2009 Coding Trends of Medicare Evaluation and Management Services OEI-04-10-00180
  • 12. 0% 10% 20% 30% 40% 50% 60% 99211 99212 99213 99214 99215 2001 2002 2003 2004 2005 2006 2007 2008 2009 Coding Trends of Medicare Evaluation and Management Services OEI-04-10-00180 Moderate MDM
  • 13. 0% 10% 20% 30% 40% 50% 60% 70% 99231 99232 99233 2001 2002 2003 2004 2005 2006 2007 2008 2009 Coding Trends of Medicare Evaluation and Management Services OEI-04-10-00180
  • 14. 0% 10% 20% 30% 40% 50% 60% 70% 99231 99232 99233 2001 2002 2003 2004 2005 2006 2007 2008 2009 Coding Trends of Medicare Evaluation and Management Services OEI-04-10-00180 Moderate MDM
  • 15.  Set level with MDM  Document History/Exam to support level  Consider  E&M coding software  Documentation templates
  • 17. Model used by 75% of practices in 2012/2013 Merritt Hawkins Survey
  • 18.  Complex Rules  Consider  E&M Coding Software  Documentation Templates  Mastery of the rules relevant to your practice is essential for financial success