If you want to make a living in today's E/M environment, you must master CPT® medical coding to maximize your revenue in the undervalued relative value unit defined system. Medicare recently eliminated consult codes for both in-patient and outpatient E&M medicine. What this means is that all physicians performing consultative services in the hospital (at least for Medicare patients) will now bill the hospital admission codes CPT® 99221-99223 instead of the consult codes CPT® 99251-99255. Make sure to get a copy of the AMA's CPT 2013 Standard Edition as the definitive resource on CPT® codes.
If the patient is not a Medicare patient, physicians can still submit consult codes to non-Medicare insurance company as many may still be paying them. Just imagine how complicated that gets as a physician when trying to decide which code to submit for which patient based on which insurance they have. We continue to submit our consult codes as if none of our patients have Medicare and let our billing company figure it out.
But none of this madness compares to the blatant self sacrifice and destruction I heard a physician consultant tell me the other day. I'm going to say it again. If you want to survive in the fee for service evaluation and management (E&M) system, you must master CPT® coding and be your own expert on every patient every time. If you are concerned about getting audited, you must understand that E/M is about following the rules with good faith. If you document appropriately, you should bill appropriately. If you want to get paid for the work you do, you must understand the CPT® process works, regardless of where you fall on the bell curve.
If the patient is not a Medicare patient, physicians can still submit consult codes to non-Medicare insurance company as many may still be paying them. Just imagine how complicated that gets as a physician when trying to decide which code to submit for which patient based on which insurance they have. We continue to submit our consult codes as if none of our patients have Medicare and let our billing company figure it out.
But none of this madness compares to the blatant self sacrifice and destruction I heard a physician consultant tell me the other day. I'm going to say it again. If you want to survive in the fee for service evaluation and management (E&M) system, you must master CPT® coding and be your own expert on every patient every time. If you are concerned about getting audited, you must understand that E/M is about following the rules with good faith. If you document appropriately, you should bill appropriately. If you want to get paid for the work you do, you must understand the CPT® process works, regardless of where you fall on the bell curve.
After asking the physician what they have been doing for the last two weeks now that consult codes have been eliminated, the response was simply to "bill a level two admit instead of a level four consult for just about everyone".
I was stunned, shocked and floored by this response.
Happy: You do realize that if you are billing a level four consult or a level two admit on your patients, just about every single one of them will qualify for a level five consult or a level three admit. Doc, you are throwing away tens of thousands of dollars a year because you don't understand CPT® coding"After I went through a brief impromptu lecture on how to bill CPT® 99232, the following conversation ensued:
Subspecialist: "Happy, maybe you do know what you're talking about"Let me run you through the mathematics of CPT® coding and how it relates to annualized revenue potential lost because you choose to bill a mid level CPT® code instead of billing for the work you actually did and should have documented.
Happy: Yes doc, I do, and you are throwing thousands of dollars out your Lexus every day."
In my state, here are payments for some common E/M CPT® codes.
99222 Mid level hospital admit code: $115
99223 High level hospital admit code: $170
99232 Mid level hospital follow up code: $60
99233 High level hospital follow up code: $90
I went back and reviewed my 2008 admission data. In 2008 I billed 313 high level admissions (99223) and two mid level admissions (99222). That's because I know how to document and billing a level two admit when you do the work of a level three admit is not only irrational, it's considered Medicare fraud to under bill. Unfortunately for you, you'll never find a Medicare audit complaining that you under bill your CPT® codes. What was my distribution of level two hospital follow up codes (99232) to high level hospital follow up codes (99233) in 2008? Of approximately 1,400 inpatient hospital follow up codes I billed in 2008, the distribution was right about 50% for each. The jump from a mid level hospital follow up to a high level hospital follow up requires a little more documentation than it does for the admit codes, but doing so helps you get paid for the work you are performing.
What does this mean on an annualized revenue basis? Let's run some numbers for my good E&M subspecialist friend I referenced above.
Coding Scenario #1
- Three consults a day being billed at midlevel (99222) and 10 follow up visits a day being billed 80% midlevel (99232) and 20% high level (99233)
- Converting this to all high level admissions (99223) and a 50% distribution for follow ups
Coding Scenario #2
- Six consults a day being billed at midlevel (99222) and 15 follow up visits a day being billed at 80% (99232) and 20% high level (99233)
- Converting this to all high level admissions (99223) and a 50% distribution for follow ups
- Before accurate coding: (6*$115 + 12*$60 + 3*$90)*365=$613,200
- After accurate coding: (6*$170 + 7*$60 + 8*$90)*365= $788,400
Coding Scenario #3
- 10 consults a day being billed at a mid level (99222) and 20 follow up visits with a 80/20 distribution between mid level and high level codes
- Converting this to all high level admissions codes (99223) and a 50/50 distribution for mid and high level follow up codes
- Before accurate coding: (10*$115 + 16*$60 + 4*$90)*365= $901,550
- After accurate coding : (10*$170 + 10*$60 + 10*$90)*365= $1.168,000
LINK TO E/M POCKET CODING CARD POST
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