Note Anxiety: Writing notes in busy clinic is driving me crazy. Any recommendations?

[thecentral09]

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Can you give an example of a typical patient as far as medical diagnoses and what you are doing as far as treatment goes to bill a level 5? I work at a large organization with a few hundred physicians and I’ve been told by the billing department that billing a level 5 should be a rarity... my typical patient would be someone with obesity, lumbar radiculopathy, spondylosis. I maybe could add on a diagnosis of diabetes or chronic anticoagulation as another diagnosis. For the plan, the most I’m ever doing is prescribing PT, a med or 2 or 3, and either ordering an MRI or scheduling an injection. Even if I order and review an X-ray in the office myself and review MRI images and report myself I’m not sure that qualifies as level 5. I feel like I bill maybe 60/40 level 4s and 3s. What is everyone else doing?


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Agree with this. More than a rare level 5 will likely put a target on your head over time

 

[callmeanesthesia]

Can you give an example of a typical patient as far as medical diagnoses and what you are doing as far as treatment goes to bill a level 5? I work at a large organization with a few hundred physicians and I’ve been told by the billing department that billing a level 5 should be a rarity... my typical patient would be someone with obesity, lumbar radiculopathy, spondylosis. I maybe could add on a diagnosis of diabetes or chronic anticoagulation as another diagnosis. For the plan, the most I’m ever doing is prescribing PT, a med or 2 or 3, and either ordering an MRI or scheduling an injection. Even if I order and review an X-ray in the office myself and review MRI images and report myself I’m not sure that qualifies as level 5. I feel like I bill maybe 60/40 level 4s and 3s. What is everyone else doing?

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What pastafan said. Read that article and it outlines it nicely. PFSH and physical exam are fairly easily to hit complete. Complex medical decision is also easy for most of our patients: new problem, additional workup planned = 4 points (or 2 new problems no additional workup is also easy); review of referral packet/PCP notes, review of radiology, and personal review of images = 4 points. You don’t have to hit high acuity to hit high complexity MDM because you only need 2 out of 3 (problem points, data points, and acuity)

 

[clubdeac]

Level 5 new office visit 99205 E/M coding, EM evaluation and management coding, e&m documentation, 99214, 99213

Wow says it was the third most commonly billed code!

"This is the third most popular code used to bill for these encounters among internist who selected the 99205 level of care for 29.66% of new office patients in 2015. The 2017 Medicare allowable reimbursement for this level of care is $209.23 and it is worth 3.17 work RVUs. Usually the problems are of moderate to high severity."

 

[Ducttape]

i never bill level 5s...

unless I get in an argument about "taking over" someone's mega high dose of opioids, and they refuse to leave.....

with my "new" approach over the past couple of years, that doesn't happen any more though.

 

[unchockey21]

I also rarely bill 5’s and by rarely I mean 1 in 3 years. I’ve been told by 2 different sets of coders that that’s the surest way to put a target on your back for an audit. As my former PD once said, “Pigs get fat. Hogs get slaughtered.”

 

[callmeanesthesia]

I also rarely bill 5’s and by rarely I mean 1 in 3 years. I’ve been told by 2 different sets of coders that that’s the surest way to put a target on your back for an audit. As my former PD once said, “Pigs get fat. Hogs get slaughtered.”

Have any of you known someone who was audited or reprimanded for excessive level 5s? I do use it extremely rarely for follow ups, but for most new patients the level of complexity does meet CMS requirements. I tried to read into it a little and found some complaints against docs who bill level 5s for all follow ups, and some cautionary articles from billers about excessive level 5s in general, but nothing that said people were having trouble with the way I’m doing it. If this really is a problem though I may have to go back to the way I was doing it, mostly level 4 for new patients, occasionally level 3 or level 5

 

[cowboydoc]

Have any of you known someone who was audited or reprimanded for excessive level 5s? I do use it extremely rarely for follow ups, but for most new patients the level of complexity does meet CMS requirements. I tried to read into it a little and found some complaints against docs who bill level 5s for all follow ups, and some cautionary articles from billers about excessive level 5s in general, but nothing that said people were having trouble with the way I’m doing it. If this really is a problem though I may have to go back to the way I was doing it, mostly level 4 for new patients, occasionally level 3 or level 5[/QU

My residency program went through a major audit, mostly for inpatient rehab, but also for clinics. The PD and chair became experts in billing and coding to say the least. Every single clinical encounter we did had documentation to justify a level 5. That said, most musculoskeletal new patient visits were billable at a level 4.

I would equate this to skimming on taxes. You will probably get away with billing level 5, but the stress of an audit, whether or not you have to pay anything back, is well worth avoiding.