Many doctors lose a significant amount of revenue because they bill lower codes than necessary. For example, even if the office visit meets criteria for CPT code 99213, many doctors will still bill the visit at a lower level. No matter how you look at it, the medical practice absorbs all of the loss in terms of time and resources consumed. That said, you can still capture this money without having to worry about it boosting the cost of patient copays.
To begin, it is important to realize that you do not need to be presented with a complex or detailed problem in order to bill at the 99213. If a normally healthy patient sees you for a paper cut, it may be suitable to bill at the lower level. On the other hand, if the patient has some type of immune disorder, the cut is infected, or located near a finger joint, it would be better to bill at the higher code. In a similar way, visits for patients with stable, but chronic diabetes, hypertension, or obesity can usually be coded as 99213.
When you are trying to choose between codes 99212 and 99213, you should always be mindful of the amount of time spent with the patient, as well as any discussions about medical history. Anything that removes your focus from the initial complaint can help you bill at the higher code. Among other things, if the patient starts talking about sinus problems, or family illness, you can document those facts in the chart. The additional diagnosis codes, plus medical history review will ensure you meet criteria for billing at the higher level. Depending on the number of conditions discussed, you may even find that the visit actually qualifies to be billed as a 99214.
Track Time with Your Patients
Depending on your outlook, you may not keep track of the time when you sit with a patient. If you remember to document the time when you begin, and the time when you finish, you are likely to find that you spent more than 10 minutes for the visit. Under these circumstances, you are literally throwing money out the door when you do not bill at a higher code. If you see 40 patients a day, an additional five minutes per patient adds up to 200 minutes of your time that is not being reimbursed. In a sense, you will be working full time, but only requesting reimbursement for half of your time.
Even though you may be hesitant about changing from 99212 to 99213 for office visits, it will be to your advantage to look at each criteria for these particular codes. If you find that you are naturally meeting the criteria for a 99213 visit, then it is worth your while to change your billing polices. That said, if you want to give away four hours of your day for free, then you might as well go on billing at the lower level. Rather than go on losing this money, you will be well served by keeping a list on hand of criteria for billing at the higher CPT level. If you feel that you need some additional reminders, you can always adjust office visit forms to ensure your notes are complete and consistent with the code being used.
Dr. Adam L. Alpers is a medical practice consultant and invites you to access and gain knowledge in enhancing your medical billing and coding by visiting http://www.medicalcodingcashsecrets.com
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