You might be losing $15 for each outpatient visit If you're not sure how to calculate a patient's risk level, you could be undervaluing your ob-gyn's medical decision-making and downcoding E/M visits -- collecting $40 per visit rather than $55. Warning: Some
ob-gyn coders misinterpret the level of risk associated with the physician's care plan. They assume that the doctor must meet the criteria for all three categories of risk: presenting problem, procedure(s) ordered, and management option(s) selected. But a single bulleted item, and the item's position in the table, determines the level of risk. Know Your Medicare Guidelines You should follow Medicare's Table of Risk to select the patient's correct risk of complications. The table has three risk categories: The patient's disease
The ob-gyn's tests and procedures
The physician's general management of the disease. The table also includes four levels of risk: minimal, low, moderate and high.
Review the following examples of conditions and treatments that meet Medicare requirements:
1. Minimal. Your ob-gyn treats a minor problem, such as a scrape. Diagnostic procedures that meet the "minimal" criteria include laboratory tests requiring venipuncture, x-rays, urinalysis or ultrasounds. Management options include rest and simple bandages. 2. Low. Typically, the patient presents with two or more minor problems, one chronic illness or an acute uncomplicated illness. Diagnostic procedures consist of superficial needle biopsies, laboratory tests that require arterial puncture, noncardiovascular imaging studies such as a barium enema, and physiologic tests not under stress. Management options include over-the-counter medications and minor surgery with no risk factors. 3. Moderate. The ob-gyn treats one or more chronic illnesses with mild exacerbation, two or more stable chronic illnesses, an undiagnosed problem, acute illness with systematic symptoms, or an acute complicated injury. For instance, a patient may present with gestational diabetes (648.83) and hypertension (401.x). In this level, diagnostic procedures consist of physiologic tests under stress, diagnostic endoscopies with no risk factors, deep needle or incisional biopsy, cardiovascular imaging studies with contrast and no risk factors, and obtaining fluid from the body. Management options include minor surgery with identified risk factors, elective major surgery with no risk factors, and prescription-drug management. 4. High. The patient has one or more chronic illnesses with severe exacerbation or progression, acute or chronic illnesses or injuries that may pose a threat to life or bodily function, or an abrupt change in neurologic status. Diagnostic procedures include imaging studies with contrast and identified risk factors, and cardiac electrophysiological tests. Management options consist of elective major surgery with risk factors, emergency major surgery, and drug therapy requiring intensive monitoring for toxicity.
"One trick I know that helps our physicians is to focus primarily on the treatment or management options portion [...]
