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: The participant will be able to: Evaluate the financial status of the clinical practice Evaluate the financial status of the clinical practice Identify common causes of lost revenue Identify common causes of lost revenue Identify opportunities for additional sources of income Identify opportunities for additional sources of income

Know Your Financial Status Know your largest payer Know your largest payer Request a monthly/quarterly statement Request a monthly/quarterly statement Meet with CFO quarterly Meet with CFO quarterly

Common Causes of Lost Revenue Office procedures Office procedures Codes not recognized by payers Codes not recognized by payers Collections Collections E&M Miscoding E&M Miscoding

Common Causes of Lost Revenue: Office Procedures Destruction of Benign Lesions (Cryo) Destruction of Benign Lesions (Cryo) Keratoses (17000/1; 17003/2-14) Keratoses (17000/1; 17003/2-14) Warts (17110/1-14) Warts (17110/1-14) Bicillin CR 1,200,000/2mL Bicillin CR 1,200,000/2mL $13/unit + injection fee $13/unit + injection fee Shave Biopsy Shave Biopsy Injection fee Injection fee Venipuncture Venipuncture Pap Smears Pap Smears

Common Causes of Lost Revenue ICD codes no recognized by Payers ICD codes no recognized by Payers Benign Lesions Benign Lesions Fatigue Fatigue Vitamin D Vitamin D Collections Collections E&M miscoding E&M miscoding

Seek Additional Revenue Contract with Businesses Contract with Businesses See Pts in LTCF See Pts in LTCF House Calls House Calls Group Visits (SMA) Group Visits (SMA)

Case Study #1 Established pt Established pt cc: sore throat 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. 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 SH: quit smoking 2 yrs ago ROS: no ear pain, no sinus pressure or drg, no cough or chest tightness/pain ROS: no ear pain, no sinus pressure or drg, no cough or chest tightness/pain Exam: BP HR 72 RR 18 T Exam: BP HR 72 RR 18 T Eyes: non-injected, no drg Eyes: non-injected, no drg ENMT: TMs clear, no nasal drg, Tonsils enlarged/erythematous with exudates ENMT: TMs clear, no nasal drg, Tonsils enlarged/erythematous with exudates Neck: cervical lymph node tenderness Neck: cervical lymph node tenderness Lungs: BBS CTA CV: RRR, no murmur Lungs: BBS CTA CV: RRR, no murmur GI: no splenomegaly; abd soft, non-tender GI: no splenomegaly; abd soft, non-tender Skin: no rash Skin: no rash

Case Study #1 Labs: rapid strep (positive) Labs: rapid strep (positive) Impression/Plan: Impression/Plan: Streptococcal Sore Throat Streptococcal Sore Throat Bicillin CR 12 units IM now Bicillin CR 12 units IM now Alternate Tylenol & Ibuprofen q 3 hrs prn fever/pain Alternate Tylenol & Ibuprofen q 3 hrs prn fever/pain Chloroseptic lozenges for sore throat Chloroseptic lozenges for sore throat Discard toothbrush Discard toothbrush RTC if symptoms persist/worsen RTC if symptoms persist/worsen

Case Study #2 cc: f/u DM, dyslipidemia, HTN 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. 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 PFSH: reviewed with no changes ROS: denies SOB, chest pain ROS: denies SOB, chest pain Exam: BP 130/78 HR 72RR 20 T 98.8 BMI 29 Exam: BP 130/78 HR 72RR 20 T 98.8 BMI 29 Overweight; normal affect; BBS CTA; RRR; no murmur; Overweight; normal affect; BBS CTA; RRR; no murmur; Impression/Plan Impression/Plan DM, Dyslipidemia, HTN DM, Dyslipidemia, HTN Continue current medications Continue current medications RTC in 30 days for labs (A1c, Lipids, CMP) RTC in 30 days for labs (A1c, Lipids, CMP)

E&M Coding (Est. Patient) CPT HPIROSPFSH111 4 (3 chronics) Exam1258 MDMSFLowModHigh Time 10 min 15 min 25 min 40 min

E&M Coding (New Patient) E&M Coding (New Patient) CPT HPIROSPFSH Exam12588 MDMSFSFLowModHigh Time

Pearls for Documenting Have Nurse/MA document history & ROS (You must document that you reviewed) Have Nurse/MA document history & ROS (You must document that you reviewed) Risk: moderate risk=level 4 visit Risk: moderate risk=level 4 visit Prescription drugs Prescription drugs 1 chronic illness w/ progression or SE of tx 1 chronic illness w/ progression or SE of tx 2+ stable illnesses 2+ stable illnesses Undiagnosed new problem Undiagnosed new problem

Pearls for Documenting Document ALL exam elements. There are 7 elements to document PRIOR to the “examination” Document ALL exam elements. There are 7 elements to document PRIOR to the “examination” General appearance General appearance Eyes: injected, no drg Eyes: injected, no drg ENT: hearing intact ENT: hearing intact MSK: normal gait/limp MSK: normal gait/limp Psych: normal affect, depressed, agitated Psych: normal affect, depressed, agitated Skin: no rash on face/arms Skin: no rash on face/arms Immunologic: NKDA (use of PMH or PE) Immunologic: NKDA (use of PMH or PE)

Pearls for Documenting Avoid “all others negative” for ROS. State the # of systems reviewed. 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” Avoid “non contributory” or “not significant to current illness” for PFSH. Recommend “was reviewed and is negative”