Medical Coding Education for Physicians,

Nurse Practitioners and Physician Assistants

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

             
              99201  $27.59             
99202-$51.54
            99203-$77.48           
      99204-$131.18     
 99205-$171.19

 

CLick Here for the CMS fee schedule lookup tool

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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. 

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.

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