Medical Coding 101
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Dr. Lander's presentation on basic coding concepts for residents and new doctors
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Medical Coding 101
- 1. Coding 100 Richard Lander MD FAAP
- 2. Why is coding important to me?
- 3. Coding tells the insurers & auditors what the patient’s problems were and what you did for them so that you can get paid.
- 4. Coding is how you will make your living.
- 5. What is a CPT and where do they come from?
- 6. CPT codes stands for Current Procedural Terminology. It is owned by the AMA. It is revised yearly and it is the standard for all medical billing.
- 7. What is a RBRVU?
- 8. RBRVU stands for Resource Based Relative Value Units.
- 9. RBRVU Developed at Harvard by Dr. Hsai to make Medicare payments more equitable, it is now the standard of payment for many private insurers.
- 10. What is an ICD?
- 11. ICD tells what illness was discovered in your examinations
- 12. ICDs have “severity” scoring systems in existence that look to see that physicians are paid appropriately for the work they deliver
- 13. Well visits
- 14. With well visits you only need to know if the patient is “new” or “established. New patients – one not seen by you or the practice in 3 years
- 15. Well visits Age CPT Code New CPT Code Established Under 1 year 99381 99391 1 – 4 years 99382 99392 5 – 11 years 99383 99393 12 – 17 years 99384 99394 18 – 39 years 99385 99395
- 16. Evaluation and Management Codes
- 17. E&M codes are for sick visits. They are based on the severity of the illness and work done.
- 18. Note: If more than 50% of visit is counseling, then time is an element
- 19. New patient codes require all 3 elements New Patients Patients only Established require 2 out of 3 elements Doesn’t require the presence of a 99211 physician
- 20. 99212 Expanded problem focused history Expanded problem focused exam Straightforward medical decision making
- 21. 99213 Detailed history Detailed examination Medical Decision making of low complexity
- 22. 99214 Comprehensive history Comprehensive examination Medical decision making of moderate complexity
- 23. 99215 Comprehensive history Comprehensive examination Medical decision making of high complexity
- 24. Why is this important?
- 25. Most doctors (pediatricians, actually) under code
- 26. What does this cost?
- 27. If you increase from 5% 99214 to 20% , you can increase your net income by $20,000 without doing any more work
- 28. You don’t want to over code because Medicaid and private health insurers can and will audit you. If the documentation doesn’t equal the code billed, they will penalize you
- 29. Evaluation requested by an appropriate professional with a report back to that person 99243 - Consult 99213 – E/M 3.17 x 36.79 1.39 x 36.79 $116.62 $51.14
- 30. Pediatricians do many procedures
- 31. If you don’t bill for the procedures you do, you cheat yourself out of the many dollars
- 32. Subluxation of elbow 24640 99213 4.85x 36.79 1.39 x 36.79 $178.43 $51.14
- 33. What does this tell you?
- 34. It is critical to know the codes for all the procedures you do, since obviously procedures pay better than E/M codes
- 35. Where can you learn more?
- 36. Decide if the practice you are looking at has someone who knows coding The Academy offers coding courses – at the NCE and as stand alone courses
- 37. Other Steps
- 38. Be sure you have a current CPT and ICD coding books in your office
- 39. USE Them