Are you still using ROS forms?

[drrosenrosen]

With changes to E&M coding removing the requirement of a "12-point review of systems" who here is still using an extensive ROS form with their patient paperwork? Is there still utility to it from a medicolegal standpoint? I of course still ask standard ROS questions that are relevant to HPI and include them in the HPI, but our EHR (Athena) has a built in tab in the chart for ROS, and I'm trying decide if we are still going to use it, or just default to "as per HPI"

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[buddababa]

With changes to E&M coding removing the requirement of a "12-point review of systems" who here is still using an extensive ROS form with their patient paperwork? Is there still utility to it from a medicolegal standpoint? I of course still ask standard ROS questions that are relevant to HPI and include them in the HPI, but our EHR (Athena) has a built in tab in the chart for ROS, and I'm trying decide if we are still going to use it, or just default to "as per HPI"

haven't used it all year, literally leave the area empty

 

[SSdoc33]

What's "review of systems"?

in short: no

 

[kstarm]

Our intake form still has it and I think it is useful if the patient fills it out. But I rarely chart anything outside of the typical things I am asking to figure out the problem. If the patient doesn't fill it out, I don't go fishing.

 

[strike5858]

Is their a good resource to look at for the new E/m coding requirements.

What else have you all trimmed back on. I’m still doing the old way and overcharting

 

[painfree23]

Bill on time - includes time for the whole encounter, not just face to face

 

[drrosenrosen]

Bill on time - includes time for the whole encounter, not just face to face

Still requires 40+ minutes for a level 4, though, and it is only direct provider time (ie doesn't include time MA spends working on chart.) I have a hard time meeting that amount, honestly

 

[drrosenrosen]

Is their a good resource to look at for the new E/m coding requirements.

What else have you all trimmed back on. I’m still doing the old way and overcharting

 

[painfree23]

Still requires 40+ minutes for a level 4, though, and it is only direct provider time (ie doesn't include time MA spends working on chart.) I have a hard time meeting that amount, honestly

U don’t think u spend 40 min: reviewing the charts , writing ur notes , ordering stuff, talking to patient, writing scripts, reviewing pmd, coordination of referrals?

 

[lobelsteve]

U don’t think u spend 40 min: reviewing the charts , writing ur notes , ordering stuff, talking to patient, writing scripts, reviewing pmd, coordination of referrals?

Would that mean you can see 12 patients total in an 8 hour day?

 

[DODOCSS]

Would that mean you can see 12 patients total in an 8 hour day?

RACS are savage, watch your 6

 

[painfree23]

Would that mean you can see 12 patients total in an 8 hour day?

It’s not face to face time? U don’t work on notes later or preachart before the patient comes?

 

[lobelsteve]

It’s not face to face time? U don’t work on notes later or prechart before the patient comes?

15 patients in total if you put in a full 10 hours. I would opine fraud occurring beyond that.

 

[Tboned]

It’s not face to face time? U don’t work on notes later or preachart before the patient comes?

I guess you could see 24 patients a day, 20 min appt slots + 20 min precharting and whatever blah blah blah for 16 hours and bill level 4s. Maybe think about patients when you sleep and bill level 5s. Boom Shaka laka 😵

 

[ED50]

Under the new coding requirements level 4s are a piece of cake to bill for. I pretty much never bill on time.

 

[painfree23]

Under the new coding requirements level 4s are a piece of cake to bill for. I pretty much never bill on time.

What do u mean?

 

[deleted131481]

What do u mean?

Look at the attachment above:

- 2 stable diagnoses OR one diagnosis with exacerbation
- prescription drug OR procedure consideration

That's all you need for level 4.

 

[myrandom2003]

Look at the attachment above:

- 2 stable diagnoses OR one diagnosis with exacerbation
- prescription drug OR procedure consideration

That's all you need for level 4.

This.

However you do need to chart more to get stuff approved.

I have been hearing more about Medicare clawing back money for ESI and medial branch blocks for inadequate documentation from a group in my area.

 

[drrosenrosen]

This.

However you do need to chart more to get stuff approved.

I have been hearing more about Medicare clawing back money for ESI and medial branch blocks for inadequate documentation from a group in my area.

Absolutely. We have four audiences for our medical documentation, in a generally escalating complexity at each level:

1) Other docs (providers) - including our future selves - to document what we were thinking and what we did when we saw the patient.
2) Payors looking at appropriateness for the E&M billing. This is "2 chronic conditions OR one exacerbated condition and meds OR procedure"
3) Payors looking at appropriateness for justification of the procedure or medication you're prescribing. This is where you have to get into stuff like "tried and failed conservative therapy including PT or physician-prescribed home exercise plan for six weeks within the past six months" or "tried and failed xyz meds"
4) State regulators looking at level of documentation for controlled substances. This is your PDMP, UDS, "five A's", etc, and vary from state to state.

So, if you were doing a cash-practice, no controlled substances, you could get by with very minimal documentation, only what is needed to document what you saw, thought about, and did at that visit. The insurance companies add another level of bs, making our notes wordier (although granted much better since the 2021 E&M guideline changes). And then if you're prescribing CIIs you have to make sure your t's are crossed and i's are dotted for the government.

And then, there's the lawyers...