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Oct 04

Evaluation and Management Coding Analysis Example

The following worksheet shows a coding comparative for a family practice. All three family practitioners perform the same type of services. Now take a close look at the worksheet and see what you can find. After the worksheet I document some of my own observations.

 

These observations will require further investigation in order to answer the questions. Answers to these questions will either improve practice revenues (downcoding) and determine if the practice is in coding compliance (chart documentation supporting codes billed). The answers might also highlight an overstatement of revenue (upcoding).

 

ABC Family Practice

Utilization for the Twelve Month Period Ended December 31, 2009

 

 

 

 

Dr. Reed

Dr. Tinsley

Dr. Akeson

CPT Code

# of Times

%

# of Times

%

# of Times

%

99201

OV, New, Straightforward

5

2.76%

0

0.00%

3

1.06%

99202

OV,New,Expanded

98

54.14%

8

2.79%

17

5.99%

99203

OV,New,Low

72

39.78%

197

68.64%

255

89.79%

99204

OV,New,Moderate

6

3.31%

82

28.57%

6

2.11%

99205

OV,New,High

0

0.00%

0

0.00%

3

1.06%

 

  Totals

181

100.00%

287

100.00%

284

100.00%

 

 

 

 

 

 

 

 

99211

OV,Est.,Minimal

68

2.88%

116

4.35%

133

6.47%

99212

OV,Est.,Straightforward

1655

70.16%

257

9.64%

226

10.99%

99213

OV,Est.,Low-Expanded

475

20.14%

2046

76.72%

1542

74.96%

99214

OV,Est.,Moderate-Detailed

125

5.30%

224

8.40%

128

6.22%

99215

OV,Est.,High-Comp.

36

1.53%

24

0.90%

28

1.36%

 

  Totals

2359

100.00%

2667

100.00%

2057

100.00%

 

Observations:

 

1.    Why is Dr. Reed recording 54% of his new patient visit new patient visits at code 99202? Is he downcoding? If so, why? Or, are the other doctors upcoding?

2.    Are Drs. Tinsley and Akeson using new patient code 99203 too much? Does the documentation in the medical record support this level of service?

3.    Items 1 and 2 also apply to the established visit services.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →