Let me start by saying that I, myself, have been in desperate search for ways to make coding easier. Efficiently assigning codes to medical procedures and diagnoses to aid in financial reimbursement from insurance and government agencies has become a hot topic. The lack of efficiency in this area is especially evident in the academic setting where physicians may not be paying close attention to which codes offer the best relative value units (RVU’s) and reimbursements… until our annual evaluations tell us we are way behind monetarily despite working like a horse. Our goal is to maximize our potential and drive sustainable growth. In order to do that, we must first understand the system.
There is a CPT committee that changes the procedure codes twice a year. A separate committee, the Specialty Society Relative Value Scale Update Committee (RUC), meets three times per year to set new values at least once every five years. The RVU’s for each CPT code is determined using three factors: physician work (52%), practice expense (44%), and malpractice expense (4%). The calculation of the fee then goes through a geographic adjustment. The RVU’s do not include adjustments for outcomes, quality of service, severity or demand. The RVU’s are then converted into dollar amounts using a conversion factor, which is updated on an annual basis according to a formula specified by statute. In 2011 the conversion factor has been $33.9764. The latest RVU’s can be found on the CMS or AMA website.
The unfortunate part of all this is, the entire coding, billing, RVU and reimbursement schedule, by which most of our work is measured, does not take into account any of the teaching, research, administrative work, publications, community service, hand-holding, calls and emails that physicians spend a considerable amount of time each day on. It is what it is, but despite all this, here are a few tips for how to make coding easier:
- Hire a medical coder or coding consultant
- There are many programs, offered in person or online, which educate and certify people in this area.
- You can outsource your coding to an online company that will you deal with innumberable governmental and private insurances, create and handle the required paperwork, coordinate customer service, manage insurance denials, and maintain proper inventory levels.
- Coders can interpret the physician’s notes and dictations into appropriate universal codes.
- Medical billing experts help the practitioner comply with current regulations, helping to avoid serious penalties for non-compliance.
- This option leaves the physician to do his/her job…patient care.
- Obtain medical coding software
- There are many medical coding and practice management software systems available to help a practice increase revenue and are specialty specific.
- These programs are equipped with search tools and customizable coding databases. Some are accessible through the Internet without the need to install software.
- The precise coding can help minimize denials, demonstrate medical necessity, ensure compliance and help organizations capture more legitimate reimbursement.
- They will help avoid under-coding and maintain compliance by preventing over-coding.
- The programs enable clinically-oriented code searches. Users can look up codes based on official condition name, commone name, acronym, or site. Code searches more closely resemble the way patients are actually diagnosed.
- Attend a coding conference or webinar
- There are a multitude of coding conferences and online resources tailored to each subspecialty. Usually during annual ophthalmology or subspecialty conferences there are coding seminars that can be very helpful.
- The AMA offers a free CodeManager webinar to teach how this product can maximize the efficiency of your coding, billing and payment process. As well, if you log onto AMA Coding Online at https://commerce.ama-assn.org/store/, you can enter into the CPT Code/Relative Value Search and by entering your state and 5 digit CPT code, the search engine will give you the fee schedule based on Medicare payments.
- As well there are coding camps that will come to your office to train and certify you and your staff.
- Learn which codes are bundled and which are associated with higher relative value units.
- Talk to your colleagues
- You would be surprised how much you will learn from merely having a conversation with someone in your same subspecialty. Present a case and see how others would code it, then discuss how you coded and why. See which way comes out ahead.
- Teach yourself
- To be honest, I just learned a ton by writing this article. My partners, staff and I, over the past few months, have realized our shortcomings when it comes to billing and coding. Rather than hiring an outside consultant right away, we have each taken responsibility for researching and learning ways to be more efficient in our coding. Start by comparing the RVU’s assigned to each CPT code that you most commonly use. A recent list can be found on the CMS or AMA website.
Coding can be a difficult and frustrating process, but obviously is a necessity. As long as the patient’s best interest remains our priority, we are headed in the right direction… meaning: treat each patient regardless of monetary value and learn efficient coding after these medical decisions have been made. Don’t choose your treatments based on how much the reimbursement will be.