Coding Table For Family Practitioners
The following worksheet shows a coding comparative for a family practice. All three family practitioners perform the same type of services. Now take a close look at the worksheet and see what you can find. After the worksheet I document some of my own observations.
These observations will require further investigation in order to answer the questions. Answers to these questions will either improve practice revenues (downcoding) and determine if the practice is in coding compliance (chart documentation supporting codes billed). The answers might also highlight an overstatement of revenue (upcoding).
ABC Family Practice
Utilization for the Twelve Month Period Ended December 31, 2009
|
|
|
Dr. Reed
|
Dr. Tinsley
|
Dr. Akeson
|
|
CPT Code
|
# of Times
|
%
|
# of Times
|
%
|
# of Times
|
%
|
|
99201
|
OV, New, Straightforward
|
5
|
2.76%
|
0
|
0.00%
|
3
|
1.06%
|
|
99202
|
OV,New,Expanded
|
98
|
54.14%
|
8
|
2.79%
|
17
|
5.99%
|
|
99203
|
OV,New,Low
|
72
|
39.78%
|
197
|
68.64%
|
255
|
89.79%
|
|
99204
|
OV,New,Moderate
|
6
|
3.31%
|
82
|
28.57%
|
6
|
2.11%
|
|
99205
|
OV,New,High
|
0
|
0.00%
|
0
|
0.00%
|
3
|
1.06%
|
|
|
Totals
|
181
|
100.00%
|
287
|
100.00%
|
284
|
100.00%
|
|
|
|
|
|
|
|
|
|
|
99211
|
OV,Est.,Minimal
|
68
|
2.88%
|
116
|
4.35%
|
133
|
6.47%
|
|
99212
|
OV,Est.,Straightforward
|
1655
|
70.16%
|
257
|
9.64%
|
226
|
10.99%
|
|
99213
|
OV,Est.,Low-Expanded
|
475
|
20.14%
|
2046
|
76.72%
|
1542
|
74.96%
|
|
99214
|
OV,Est.,Moderate-Detailed
|
125
|
5.30%
|
224
|
8.40%
|
128
|
6.22%
|
|
99215
|
OV,Est.,High-Comp.
|
36
|
1.53%
|
24
|
0.90%
|
28
|
1.36%
|
|
|
Totals
|
2359
|
100.00%
|
2667
|
100.00%
|
2057
|
100.00%
|
Observations:
1. Why is Dr. Reed recording 54% of his new patient visit new patient visits at code 99202? Is he downcoding? If so, why? Or, are the other doctors upcoding?
2. Are Drs. Tinsley and Akeson using new patient code 99203 too much? Does the documentation in the medical record support this level of service?
3. Items 1 and 2 also apply to the established visit services.
Have questions? I’m here to help.
