Maximizing Revenue through Accurate Coding, Billing, Documentation, and Compliance

This Webinar is recorded and if you can watch it anytime, anywhere. If you select just one, this should be it. Note that it does assume a basic knowledge of concepts and guidelines. If you discover you need additional training, select our Beginner Bundle of Webinars (only $125) on our Order Form.

1. Documenting and reporting 920xx codes

2. Documenting and scoring E & M office visits

3. Know how to score MDM.

4. Updating your fee schedule. Understanding RVU’s

5. Understanding medical necessity

6. Medicare Guidelines and Tips

7. Learn how to appeal denied claims.

8. Reporting optimal levels (audit-proofing your clinic)

9. Knowing information not in the CPT manual (e.g., unilateral vs bilateral codes)

10. Work screenings for high-risk drugs

11. Niche markets: psychiatric, neurology, orthopedics, pediatrics

12. How to document the Interpretation and Report for diagnostic tests

13. A little something extra on ICD-10 (Appendix)

Update to explanation for initial versus a subsequent encounter

This is an update and correction concerning the explanation for initial versus the subsequent office visit encounter (follow-up) for any injury.

In both the live and recorded course I used the new patient and existing patient guidelines to determine whether the visit was initial (XA) or subsequent (XD). While there are some grey areas in the official explanation I am revising my opinion on this matter based on additional information and feedback. The bold and italics below are mine.

This is per the AHA ICD-10 Coding Guidelines Manual Nov 2014 (Chapter 19: pgs 66-67) (full document link at the end of this article):

7th character “A”, initial encounter is used while the patient is receiving active treatment for the condition. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.

It could be argued whether the list above means “and” or “or.” Is the new physician a requirement or does the active treatment by any new physician determine it’s initial?

7th character “D” subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following treatment of the injury or condition.

The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the 7th character “D” (subsequent encounter).

Additional Notes are from the article below:

Per Guest Contributor, Debra Mitchell, MSPH, CPC-H, In Coding Edge April 1, 2014,  “Take the patient’s perspective when appending the seventh character in ICD-10-CM.”

The statement “evaluation and treatment by a new physician” can be a source of confusion, but you will code correctly if you are able to answer the basic question, “Has the patient previously received active treatment for this condition in any setting or by any provider?”

Per this article, her take is that if the patient saw another doctor in Florida or in the ER for a foreign body in their eye and are now seeing you as a follow-up , then it would be coded as subsequent, not initial based on new versus established patient guidelines.  This is different from my 2014/2015 ICD-10 classes and the recorded training. Based on this new information, I am revising my opinion on this pending any confirmation by Medicare or other official sources (AHA, AHIMA).

I was not able to get any additional confirmation or determine if other information was used to determine this interpretation.

However, per the article, if the patient did not receive active treatment (e.g., remove the foreign body) then this encounter would be the initial, not subsequent. So there is some grey area here. The key is to be consistent in your interpretation among doctors and staff.

The rest of the article explains active treatment:

For example: The patient is evaluated in the emergency room (ER) for a displaced transverse fracture of the left ulna that cannot be managed at this time. The ER applies immobilization and ice and instructs the patient to follow up with orthopedics in the morning. This would be reported using S52.222A Displaced transverse fracture of the left ulna, initial encounter for closed fracture.

When the orthopedist rechecks the patient and reduces the fracture the next day, the patient is receiving initial active treatment for this fracture. That is, this is the first encounter at which the patient receives definitive care (the ER was able to apply comfort care only). Per ICD-10 guidelines, you would again report S52.222A for an initial encounter.

Usage of XA or XD hinges on interpretations of “active treatment” and “definitive” care. If the ER doctor removed two FB from the patient’s eye  but on the subsequent visit to the OD, another FB particle is found and removed, is that an initial or subsequent visit? Based on the interpretation above, I would now code it as subsequent–the patient did receive a foreign body removal service. Think of subsequent as “aftercare” regardless of whether you continue with the treatment or simply monitor it.

For those who know me, I always defer to official sources and I  confirm whether what I am stating is based on my professional opinion or a specific source. Sometimes there is very little official documentation to follow.

I will continue to monitor the definitions and usage of “initial” versus “subsequent” and send my findings to all the EyeCodingForum ICD-10 clients. I will post findings to my website as well. The complete guidelines are below:


Jeffrey Restuccio, CPC, CPC

Does the chief complaint “lock you in?”

This is from a national Medicare Regulations and Guidance Transmittal dated August 8 2014. [The original link is here].

I’ve been asked, many times over the years, regarding the guidelines concerning the chief complaint for an Evaluation and Management office visit. While the specific example below does not refer to Eyecare, it is an official position on whether the provider can use a confirmed diagnosis when the patient presents with only signs and symptoms. The text is below:

“For outpatient claims, providers report the full diagnosis code for the diagnosis shown to be chiefly responsible for the outpatient services. For instance, if a patient is seen on an outpatient basis for an evaluation of a symptom (e.g., cough) for which a definitive diagnosis is not made, the symptom is reported.  If, during the course of the outpatient evaluation and treatment, a definitive diagnosis is made (e.g., acute bronchitis), the definitive diagnosis is reported.”

Jeffrey Restuccio, CPC, CPC-H, MBA

May 29 2014: Medical Decision Making (MDM) for E & M Visits

May 29 2014: Medical Decision Making (MDM) for E & M Visits: The three key components for determining the level of an E & M exam are History, Exam and MDM. Most providers do not know how to score and calculate their level of MDM. Most EMRs do not calculate it and this can lead to upcoding–which is a compliance violation or downcoding, which is simply losing money you legitimately earned.

The Webinar is 50-minutes on Thursday, May 29, 2014, noon central time. It will be recorded so anyone in the clinic can view it anytime. This is primarily for the providers and it goes into detail on proper documentation and how an auditor will look at your MDM.

There are three MDM Tables:

  1. Number of Diagnosis and Management Options
  2. The amount and/or complexity of data to be reviewed
  3. Table of Risk/Level of Risk

You need two of the three above to be at a certain level.

The Table of Risk includes three components (or tables):

  1. Presenting Problem
  2. Diagnostic Procedures
  3. Management Options

You need only one of the three above to be at a given level (Minimal, low, moderate or high)

Jeff has presented this Webinar nationwide several times plus live. It is essential for anyone reporting E & M encounters and in particular level IV (99214 or 99204) encounters.

Again, it will be recorded and will be available all year.

Exam elements and Medical Decision Making for Eyecare

Downloads are found under the “downloads” tab on our main menu.

Just enter your name and e-mail and download valuable documents that will help you earn every penny for every service you perform confidently and compliantly.

Click here to be forwarded to the document list below.

In the majority of my live seminars I discover that most Eyecare professionals are not aware of the specific elements for a comprehensive exam (either 920xx or 992xx). In other words, if you performed every element, how many would that be exactly?

What is your answer?

And what other exam elements are you responsible for that are not included in the Medicare list? Do you know this answer?

How are E & M visits levels determined?

How do you determine the level of Medical Decision Making (MDM)?

The documents will help you with these questions. I’ve also included two lists of high risk drugs you can perform yearly screenings.

  1. E & M Elements for Eyecare (Medicare 1997 E & M Guidelines) Same elements for 920xx exams.
  2. Medical Decision Making Score Sheet
  3. List of high risk drugs 1
  4. List of high risk drugs 2
  5. List of ICD-9 codes with more specificity and a required second code (code also)
  6. Article on other diseases discovered during a routine eye exam.