Power Up Your Primary Care Coding By SuperCoder

1
Power Up Your Primary Care Coding
Speaker Nikki Taylor, MBA, CPC, COC, CPMA,
CRC, AAPC Fellow
2
Learning Objectives

• Nail down undercoding and overcoding mistakes and
  learn how to prevent them
• Learn the ins and outs of telemedicine services
  and proper billing
• Eliminate counseling confusion and capture
  maximum revenue
• Sharpen your vaccination coding skills and learn
  how to avoid common mis-steps
• Brush up on modifier 25 and preventative services
  coding
• Highlight helpful tools and resources to help
  ensure Primary Care coding success

3
Know the Facts Undercoding and Overcoding

• Undercoding Coding a service at a lower level
  than appropriate
• Overcoding Coding a service at a higher level
  than appropriate
• Both are problematic!
• Creates incorrect utilization patterns
• Both may be considered a violation of fraud and
  abuse rules
• Do not play it safe by undercoding!

4
Know the Facts Undercoding and Overcoding, cont.

• Common with E/M coding, but can occur with any
  service
• Always select the most appropriate code
• Know E/M guidelines and how to select service
  levels

5
Know the Facts Undercoding and Overcoding, cont.

• Three Key Components
• History
• HPI
• ROS
• PFSH
• Examination
• 1995 vs. 1997 Examination Guidelines
• Medical Decision Making
• Number of Diagnoses or Treatment Options
• Amount and/or Complexity of Data
• Risk of Complications and/or Morbidity or
  Mortality

6
Know the Facts Undercoding and Overcoding, cont.

• History
• HPI
• ROS
• PFSH

Description of Illness/Injury Review of Systems
with Patient Past Medical, Family, and Social
History
7
Know the Facts Undercoding and Overcoding, cont.

• History of Present Illness
• Must be documented by the provider
• 8 Elements of HPI

• Location
• QUALITY
• SEVERITY
• DURATION
• TIMING
• CONTEXT
• MODIFYING FACTORS
• ASSOCIATED SIGNS/SYMPTOMS

Chest pain Burning, dull Better, 6 on a scale of
1-10 1 week Off and on, occasionally After
eating Took antacid Nausea and Vomiting,
heartburn
8
Know the Facts Undercoding and Overcoding, cont.

• History of Present Illness
• 8 Elements of HPI
• Insufficient
• No Modifying Factors
• No Associated Signs or Symptoms
• Patient Not Sure-Duration of Symptoms
• Comprehensive Level 4 or More HPI Elements

9
Know the Facts Undercoding and Overcoding, cont.
Review of Systems
10
Know the Facts Undercoding and Overcoding, cont.

• Past Medical
• Patients past medical experiences
• Trauma
• Hospitalizations
• Illnesses
• Injuries
• Surgeries
• Current medications/Dietary status
• Allergies

11
Know the Facts Undercoding and Overcoding, cont.

• Family History
• Medical history of the patients family
• Health / status of parents/siblings
• High risk of disease
• History related to the chief complaint, HPI or ROS

12
Know the Facts Undercoding and Overcoding, cont.

• Social History
• Past and current social history
• Education/Occupation
• Marital status
• Living Situation
• Present or history of drug, alcohol, or tobacco
  use

13
Know the Facts Undercoding and Overcoding, cont.
Level of History History of Present Illness Review of Systems PFSH
Problem Focused Brief (1-3) N/A N/A
Expanded Problem Focused Brief (1-3) Problem pertinent (1) N/A
Detailed Extended (4) Extended (2-9) Pertinent (1)
Comprehensive Extended (4) Complete (10) Complete (ED2)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
Recap

• Undercoding is just as bad as overcoding!
• Can be considered fraudulent and abusive billing
  practices
• Surgical and E/M can be overcoded or undercoded
• Telemedicine is beneficial to patients and
  providers
• Know the rules

18
Recap, cont.

• Dont leave money on the table!
• Ensure no missed counseling and screening
  services
• Tighten up same day sick and preventative
  services
• Ensure accurate vaccine coding
• Remember modifier 25 guidelines

19

• Recap, cont.
• Helpful Tools and Resources
• SuperCoder.com
• CCI edits checker
• Code details for telemedicine codes
• Medicare fee schedules
• EM Auditor
• And more

20
References

• www.cms.gov
• www.supercoder.com
• AMA CPT 2018
• AMA Medical Record Auditor

21
Click Below to Read Download Full
PPT https//www.supercoder.com/medical-coding-web
inars/power-up-your-primary-care-coding
56