Medical Office Coding – Its not about the shoes!

Over the years as an administrator and consultant I have been regularly surprised by some of the methodologies used by physicians to assign a CPT code for a patient encounter. My favorite was a cardiologist from Ohio who always used a 99213 unless the patient had beat up shoes, in those cases he would give him a break and only charge a 99212. Both I and our coders would explain the methodology to determine the appropriate CPT code, but to the physician our request for additional consideration in making this decision seemed to be asking too much.

As we look at the continuing development of electronic medical record software there has been a strong focus to developing embedded coding tools to assist the physician by suggesting a CPT code. This helps with guidance but accurate CPT coding is a skill that requires training, feedback, and attention to changes in CPT coding requirements. I am a VP of Hospital and Consulting Services at MTBC, a medical billing solutions provider with over 1000 physician clients. The challenge to educate these clients through coding and documentation reviews is a focus of ours. It has to start with reviewing the documentation and giving the physician feedback and recommendations. Physicians are data driven and are fearful of the possibility of a payor audit. The best way to minimize the physicians audit exposure is to review the encounters, provide the data, and educate. Using certified coders to review the physicians coding and provide that feedback can assist a physician in his or her compliance to established CPT coding guidelines. So forget the shoes, regular reviews and follow-up will assure the physicians coding is current and accurate.