er documentation and billing?

[winkleweizen]

Any suggestions on how to learn the ins and outs? Books? My residency does a good job teaching us the medicine, but we have very little formal education on this.

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[southerndoc]

Any suggestions on how to learn the ins and outs? Books? My residency does a good job teaching us the medicine, but we have very little formal education on this.

Most of your billing will be done by coders.

 

[Greenbbs]

Most of your billing will be done by coders.

But some of it needs to be done by you, especially the inpatient/obs decisionmaking process. Your documentation and how you put the diagnosis in makes the billing happen with this.

E.g. Kidney stones who you can't get comfortable w/o hydro need 3 doses of pain mess to meet inpatient, but if you have hydro, it meets inpatient no matter what.

You should be able to know the basics of this stuff because some places do track your utilization of resources like this

 

[Janders]

Also important if you care about your professional revenue. I.E if you are in a democratic group where your income is tied to your billing, or any group with RVU based payment/bonusing, or even as an employee if you want your department to get all the $$$ it deserves.

ACEP has some decent overviews of this stuff, I suggest you read ALL the links on this page--
http://www.acep.org/reimbursement/
and
http://www.acep.org/pearls/

The first part is to understand what goes in a lvl 3 vs 4 vs 5 chart. Then to understand the hows / whys of Critical care billing (underused by many people). Then understand proper charting of procedures. Then understand obs (gets a bit more complicated). Once you understand all of that you are doing pretty well.

The entire obs/inpatient thing is much more of a game; helpful to have case management in department to help you with that. It does not directly tie into your reimbursement as an EP, but certainly matters to the patient and the hospital.

 

[southerndoc]

Also important if you care about your professional revenue. I.E if you are in a democratic group where your income is tied to your billing, or any group with RVU based payment/bonusing, or even as an employee if you want your department to get all the $$$ it deserves.

ACEP has some decent overviews of this stuff, I suggest you read ALL the links on this page--
http://www.acep.org/reimbursement/
and
http://www.acep.org/pearls/

The first part is to understand what goes in a lvl 3 vs 4 vs 5 chart. Then to understand the hows / whys of Critical care billing (underused by many people). Then understand proper charting of procedures. Then understand obs (gets a bit more complicated). Once you understand all of that you are doing pretty well.

The entire obs/inpatient thing is much more of a game; helpful to have case management in department to help you with that. It does not directly tie into your reimbursement as an EP, but certainly matters to the patient and the hospital.

I do work in a fee-for-service/productivity model. So yes, it's important to know how to document. Perhaps I misunderstood the question as I thought he was asking about coding.

 

[SkiingDocMD]

Treatment of Rib Fracture -- CPT 21800

Are people using this frequently? this is one of the most commonly coded CPT codes. I assume these are mostly "clinical rib fractures," as I find it hard to believe that people are diagnosing more rib fractures on CXR's than doing I&D's of abscesses.

I imagine to bill this one would need to make a final diagnosis of rib fracture, not chest wall pain.

 

[had2piknowEM]

Treatment of Rib Fracture -- CPT 21800

Are people using this frequently? this is one of the most commonly coded CPT codes. I assume these are mostly "clinical rib fractures," as I find it hard to believe that people are diagnosing more rib fractures on CXR's than doing I&D's of abscesses.

I imagine to bill this one would need to make a final diagnosis of rib fracture, not chest wall pain.

Actually, this CPT code was eliminated this year. You can no longer separately bill for closed treatment of rib fractures. It is now part of your E/M service.