Presentation on theme: "CODING and RVU’s: What AHLTA Can Do For You (and what it can’t)!"— Presentation transcript:
1 CODING and RVU’s: What AHLTA Can Do For You (and what it can’t)! Cyborg Coding: Episode OneCODING and RVU’s: What AHLTA Can Do For You (and what it can’t)!USAFP ConferenceMarch 2007Mark Stackle, MD
2 Coding Basics—The Dry Stuff Evaluation and Management Coding2/3 areas for Established Patient (History, PE, MDM), 3/3 for New Patient99214 (4-2-1, 12)HISTORY: 4 HPI, 2 ROS, 1 PFSHPHYSICAL: 12 PE Bullets99213 (1-1-0, 6)HISTORY: 1 HPI, 1 ROS, 0 PFSHPHYSICAL: 6 PE BulletsWhat about a 99212? Only for the very straightforward cases.99212 (1 HPI, 0 ROS, 0 PFSH), 1 PE BulletS: CoughingO: AlertA: CoughP: Drink Water = 99212Most visits should be or 99214
3 MDM (Choose 2 of 3 Components) MDM Components99213 (Low)99214 (Mod)#/Stability of DxMinor problem (max of 2) = 1Established problem, stable = 1Established problem, worsening = 2New problem, no work up = 3New problem, work up planned = 42 points3 pointsComplexity of DataReview or Order Lab/Rad/Test = 1 eachDiscuss case with other physician = 1Independent Review of image or specimen = 2Review and summary of old records = 2Table of Risk (just need 1 from this list)*OTC drug*IV fluid*2 minor problems*OT/PT*Prescription drug*IV fluid with additive*Illness with systemic symptoms (flu, pneumonia)*2 Chronic problems, stable
4 Medical Decision Making The AHLTA Coding Tool does not currently fully reflect the MDM coding rules.It will weigh certain diagnoses more heavily than others (MI gets more points than URI) and give you credit for multiple diagnosesIt does not capture medication orders (remember ordering a prescription RX should give you a for Problem Risk)No way to capture medical records reviewed and summarized which would usually get you points for Complexity of DataThis is improved in AHLTA build 838 Patch 20OPTIONS:1) Focus on H&P and take what AHLTA gives you2) Learn MDM coding rules and manually code that section on the Disposition page.
5 Coding Basics Time Based Coding (Counseling, Coordinating Care) Greater than 50% of time spent…99213 – 15 minute appointment time99214 – 25 minute appointment time99215 – 40 minute appointment timeDocumentation should be driven by medical necessity!
7 The Disposition Module Where AHLTA Coding Comes Together!
8 The Disposition Page is Crucial To Accurate CodingDocument here if you spent >50% of the total appointment time counseling, educating or coordinating care.*Important to have statement in note specifying the amount of time and content of information discussed2) Ensure you document actual patient care time here if you are counseling for more than 50% of that time.99212 (0.45 RVU): min appointment time99213 (0.67 RVU): min appointment time99214 (1.10 RVU): min appointment time99215 (1.77 RVU): >40 min appointment time
9 There are different E&M codes for new vs existing patient with different RVU’s. (typically you get more RVU’s for a new patient vs. existing patient)New Patient = one who has not had a visit in the MEPRS code within the past 3 years. (e.g. they may have been seen in the Pediatrics Clinic, but not in the Family Practice clinic—this is a new patient to the Family Practice clinic.**Important—AHTLA automatically defaults to Existing Patient—you have to make manual change to New Patient
10 There are different E&M codes for preventive medicine visits (well woman, well child, military physical, etc. . .).These prevention visits usually result in more RVU’s and assume a comprehensive history and physical. These are age based which AHTLA does automatically calculate3) Again, you have to manually select this, by selecting PREV MED EVAL/MGT from drop down menu.A (Outpt visit, existing patient) = 1.1 RVUA (Prev Med visit, existing patient) = 1.36 RVUA 26% RVU increase!!!Select Here
12 Sample RVU ValuesProposed target for Family Practice is approximately 16.0 RVU/Provider/DayNew versus Establishedmore RVUs for new patients, but greater documentation requirements)E&M Codes New/EST99202/99212 (Prob Focused) /0.45 RVU99203/99213 (Exp Prob Focused) 0.88/0.67 RVU99204/99214 (Mod Complexity) 1.34/1.10 RVU99205/99215 (High Complexity) 2.67/1.77 RVU99381/91 (Prev Med 0-1 yo) /1.02 RVU99382/92 (PM 1-11 yo) /1.19 RVU99385/95 (PM yo) /1.36 RVU99386/96 (PM 40-64) /1.53 RVU
13 So What Do RVU’s Mean to Me? If considering E&M coding only, a provider coding only (0.45 RVU/visit) and NO procedures would need to see approximately 36 patients per day to achieve 16.0 RVU/Providers/Day.A provider averaging a (0.67 RVU/visit) and NO procedures would need to see 24 patients per day.A provider seeing 20 patients ( , ) yields over 16.0 RVU/day without including Procedures.
14 TELCON RVUs Telephone Consults count, too This is different from civilian practiceA (brief phone call) counts as RVUA (intermediate phone call—i.e. made new diagnosis, made treatment change, discussed results in detail) is 0.60 RVURemember a visit = 0.67 RVU
17 PROCEDURES Correct documentation of procedures is ESSENTIAL! Procedure RVU’s are added to the E&M code.For example: visit for impaired hearing (E&M = 0.67) + ear wax removal (RVU = 0.61). TOTAL = 1.28 RVUIMPORTANT: Providers can receive credit for procedures done by ancillary staff.
19 Procedure RVU Nebulizer Treatment 0.32 RVU EKG Interpretation 0.17 RVU Cryotherapy of skin RVUScreening Pap by Physician 0.37 RVUIM/SC Injection RVUProstate CA Screening (DRE) 0.17 RVU
20 What About Procedures?A Properly Coded Well Woman Exam can yield big RVU’s:E&M Prev Med visit (99395) = 1.36 RVUProcedure: Screening Pap Smear (HCPCS Q0091) = 0.37 RUV,1.73 RVU for a 30 minute appt.(You would only need to see 10 well woman patients to exceed the 16.0 RVU/day goal)
21 So how do I code procedures in AHLTA? 2) Select Type of Procedure(Most are CPT codes, but a PAP (0.37 RVU) or Digital Rectal Exam (0.17 RVU) for Prostate Cancer Screening are two important HCPCS codes for FP)**AHLTA defaults to CPT**1) Select Procedure Tab4) Double click or select ADD TO Encounter3) Search by name or number: Peak Flow or (94150)
22 Recommend putting frequently used Procedures into Favorite List If done correctly, the Procedures will be listed in the A/P module here.Recommend putting frequentlyused Procedures into Favorite Listor into an Encounter Template foreasy access
32 Other Quick AHLTA Coding Nuggets: Has anyone ever noticed that musculoskeletal based visits seem to get very low codes (99212’s)?Musculoskeletal Exam bullets are only counted if they are localized to a specific sidei.e you will get zero physical exam bullets for saying that bilateral knee motion is normal, but you will get 2 bullets for saying that the R knee motion was normal and the L knee motion was normalSystem Specific ExamsSee next slide
33 You can also change exam type if your exam is focused on a certain system. (The HPI, ROS, PFSH, and Exam coding requirements are the same.
34 You can now see that you have more exam findings available for a given system. (In this example, you now have 11 Genitourinary exam bullets available instead of only 6 in the General Multi-System exam. (You may choose to use whichever Exam Type gives you the highest code)
35 KEY POINTSKnowing how to document accurately and completely results in improved RVUs/Provider/DayProcedures are a critical element of RVU generationCounseling/Education (if >50% of visit)—make sure to provide supporting documentationNew vs. Existing Patients (remember if a patient hasn’t been seen in that clinic in 3 years, they are a new patient)Outpatient Visit vs. Preventive Medicine VisitsMore bullets doesn’t necessarily mean a higher code
36 My kids weren’t happy to see this at Christmas…
39 TELCONS99371Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals:simple or briefreport on tests/lab resultsclarify or alter previous instructions integrate new information from other health professionals into the medical treatment planadjust therapy99372Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionalsIntermediateprovide advice to an established patient on a new probleminitiate therapy that can be handled by telephonediscuss test results in detailcoordinate medical management of a new problem in an established patientdiscuss and evaluate new information and detailsinitiate new plan of care