# lots of questions!!!



## cathyjo (Apr 15, 2010)

we have had an audit done by a company that wants to take over the billing for the group of doctors i am currently employed by...      there were several discrepancies from what they said, to what we are doing.   can you let me know how you handle these scenarios?    please try to list each separately..thanks so much!

1.  If an OCL splint, knee immobilizer etc are applied by a tech or nurse, but our doc marks that he checked the nv alignment...can we charge for the splint?  in either case, what E&M code would you charge. (we would charge a level 3 and the splint.   They said they never charge the splint and would charge a level 4)  

2.  Would the answer change if it was applied by the doc or pa themselves?

3.  If an IV of morphine, dilaudid or other pain med is given, does this automatically increase the level?  On a particular visit we may charge a level 4, they said they would charge a level 5, and the only reason being that one of these IV's were given.

4.  We use the T-chart system.  If you use these, do you use the electronic report that is actually the hospitals documentation (but the info is entered by our docs) to support the tchart, or does all the info have to actually be on the tchart?  (such as the splint, radiology, ...)

5.  Does a CT, Ultrasound, etc (radiology) automatically become a level 4?  Even if only one test is done?

6.  If a prescription is given on discharge, does it automatically become a level 3?

7.  Do you always count data points..3 for a level 3 or 4, 4 for a level 5...  Can you use the risk level to get a higher level, if not enough data points are there?

8.  Is it correct that documenting a progress note, giving IV's, or writing a prescription does not count as a data point?

Thanks for giving me some feedback....  this audit company has promised our docs to really increase their revenue...we don't see how they can do it...


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## kmhall (Apr 16, 2010)

*A few answers*

I will try to help you with some of these questions but do not know the answer to all.  Here goes:

1.  Charge for the orthosis.  The EM code would depend upon physician documentation and would be based on many factors, not just on the basis of ordering a test, applying a splint etc...  All of these things would need to be considered but would not be the sole basis for the level of service.

2.  No.

3.  Again, you could not base the level of service soley on the fact that an IV was given.  Many other circumstances would need to be considered.  You would get a *Moderate* level of risk under Management Options of MDM (1995 guidelines) but this alone would not decide your level of service.

4.  Not familiar with the T-Chart system.

5.  Again, you cannot base the level of service soley on the number of tests ordered.

6.  Refer to answer #5 above.

7.  Not sure what you are asking here.  Data points are assigned according to the amount and complexity of data for the visit.  The risk level is assigned according the presenting, problems, diagnostic procedure or management options.  And again, this alone does not decide the level of service.

8.  True.

I have an audit worksheet based on the 1995 guidelines and would be happy to forward you a copy if you are interested.  I hope I have answered some of your questions and maybe someone else can help you as well.  Good Luck!


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## KellyLR (Apr 27, 2010)

*The company that did the audit*

Was the company that did the audit based from India and working in the U.S. having satellite offices here?  I know of one who did an audit for one of my favorite practices and had the physicians in stitches for days because that company told my guys and gals that they needed "them" to help optimize their system.  Well, once I got with my EMR/Billing software company and we worked on showing my people the "true" figures and showed justification, it blew those representatives from India away and they wanted a copy of our reports to imitate.  How shrewd!  Needless to say, there is much competition from outsourced companies to take business away.  I would investigate and prove yourself. BTW, the free audit that they did, they recently billed for and I shredded it and mailed it back with a note that said, "Free Audit" does not come with a bill.  Not documented, didn't happen.


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## kak6 (Apr 28, 2010)

Please do not laugh too hard this is true. There are companies out there doing this very thing I worked for one of them. All the questions you asked are true and yes they increase revenue dramatically. One company in particular, is in the process of sending all the coding "off shore" to India. Our Dr's and hospitals here in the good ol' U.S. evidentally do not care because it increases profits for them, while it reduces jobs here. I will send you an email.


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## sparkles1077 (Apr 28, 2010)

I think kmhall pretty much covered the answers, but I just wanted to add on number three.  They are getting this from the audit sheet which indicates parenteral substances are high risk.  However, just because morphine is given does not automatically make it a level 5.  Like kmhall said, there are many other factors involved.  Our ED physician indicated that none of the ED physicians felt services should automatically be considered a level five based on the patient receiving morphine.


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