Why should the medical practitioner understand E and M coding?
Medical practitioners such as physicians, nurse practitioners and physician assistants spend years learning how to practice medicine and serve their patients. However, very little time is spent teaching practitioners how to be correctly compensated for their services. For years companies have tried to force physicians, nurse practitioners and physician assistants to understand the fundamentals of evaluation and management coding (E and M coding). However, it has always been done utilizing antiquated teaching models.
So what is E and M coding?
E and M coding is how the medical practitioner is paid for the service that they provide to the patients that they see on a daily basis. Just like a CPT code is attached to an x-ray when it is ordered, the same happens with the office visit. The CPT code that is used and therefore the amount that is paid is based entirely off of the documentation provided by the provider. Unfortunately most practitioners feel they should be paid based on the "difficulty" of the the patients visit. CMS has specific criteria that must be documented for each level of service. As the complexity of the office visit and time required with the patient increases so does the amount of money the insurance company is willing to pay.
There are five levels of service for both new patients and established patients with level 1 being a visit requiring very little medical decision making and a level 5 visit being a potentially life threatening situation that requires great deal of medical decision making. As you would expect most medical providers seeing patients is the out patient setting code primarily as a level 3 visits. The reasoning is that the patient is not having a life threatening event, however they do require some work therefore the provider codes in the middle of the five levels of service. Unfortunately this costs each practitioner roughly $40,000 annually (Click here for article supporting estimate).
So whats the difference in reimbursement for each E and M code?
2019 E and M medicare fee schedule for new patients
CLick Here for the CMS fee schedule lookup tool
As you can see from the new patient fee schedule there is a significant difference in reimbursement just by being off by one level of service. It is for this reason that the average provider loses $40,000 annually through improper coding and documentation. For example, based on the above fee schedule under coding 3 charts per day as 99203 rather than 99204 a provider can lose a practice $ 35,442 annually per provider.
If you feel that you or your practice then please check us out and feel free to reach out to me for a free phone call to answer any coding question you may have.
Physician Coding Resource is medical coding training designed for the physician, nurse practitioner and physician assistants.
As your medical coding consultant, we offer medical coding training for physicians, nurse practitioners and physician assistants. Our program is approved for 20 hours of CME for physician assistants and nurse practitioners.
Physician Coding Resource is a company founded by medical practitioners. Our goal is to eliminate the fear associated with coding correctly and to increase revenue for medical practices. Through medical coding education for the physician we can increase clinic revenue without adding a new service.
Physician assistants and nurse practitioners earn 20 hours of AAPA category 1 CME while learning to increase revenue per patient through proper documentation for medical coding purposes, which is part of the reason it’s so important to learn medical billing.
Using our LMS platform we will put each of your practitioners through our training modules to lay the foundation of knowledge needed to implement in the practice setting. By avoiding the 6-8-hour long training session and opting instead for just four 30-minute modules your providers will retain and utilize the tools given.
For those practitioners who need a more personalized touch, we will utilize our LMS platform to bring you individualized coaching, so you can learn medical coding. By using our LMS we can share the charting documents and see the individual practitioners giving a personal feel in a modern setting.