Barb is a coding veteran with 20+ years of experience as a coder and trainer, plus as a leader of the Board of Medical Specialty Coding’s Evaluation and Management Auditing Specialty Advisory Board, and the lead developer of Board of Medical Specialty Coding’s Advanced Coding Specialist – Evaluation and Management Auditing (ACS-EM) exam. Barb brings a unique combination of physician office management and chart auditing experience to her programs. Every year, she conducts more than a dozen sold out chart auditing seminars throughout the country.
As a specialty practice, you might think you can just blow off your E/M coding – your doctors do higher priced services so why sweat the little E/M codes? Here’s why: Undercutting yourself from a level 5 to 4 or 4 to 3 – is costly mistake that snowballs when you look at volume. Plus, auditors don’t cut you any slack – in fact they are relishing the specialists’ foray into E/M coding.
Consider this…
- A report by CMS on provider billing errors says you and your peers left $100 million in underpayments on the table - millions of which were from underbilling common E/M services.
- The OIG has identified physician evaluation and management (E/M) billing as a top priority for scrutiny in 2008.
Medicare’s guidelines for E/M documentation can be a challenge for even the most seasoned coder –not only do you need to understand the 1995 and/or 1997 Documentation Guidelines, but also the nuances of what CPT® requires in their descriptions of the various codes.
Don’t let your practice land in the audit hot seat, let veteran chart auditor Barb Pierce, CCS-P, ACS-EM, walk you through the steps of E/M chart auditing to make sure your practice is coding at the correct level of service. Make this your “in-service” for September and invite your entire staff to join you and find out:
- How to choose which type of exam –specialty vs. general or 95 vs. 97 you should use based on your specialty.
- Discover where the bullets hide – they are not always in place you expect – for instance, where will you find the bullet for clubbing and cyanosis? If you're looking at the General Multi-system bullets, it's in the musculoskeletal box. But, on some of the specialty-specific exams, it's in the extremities box. And really, what system(s) is being evaluated by checking for clubbing and cyanosis?
- How to count the exam bullets. Take ‘muscle strength and tone’? Can it just be counted once, or do you get to count it multiple times, based on the number of extremities? The answer depends on the specialty criteria you are using.
- What's so special about the eye and psych specialty exams and how to use this to your advantage if you are auditing ophthalmology or psych records. Plus, get tips for those that have no specialty exam (podiatry, GI, general surgery are just a few)
BONUS: Go through a real chart note and complete the audit tool to make sure your answer meets an auditor’s rigorous standards.
