Pediatric Coding Alert

This practice was losing $32 per chest x-ray -- but not anymoreKeeping your practice from taking advantage of the so-called E/M "loophole" is a little easier if you offer alternative safer ways to find additional income and root out revenue robbers."As of 2006, nearly 60 percent of doctors polled by the American College of Physician Executives said they had considered getting out of medicine because of low morale, and nearly 70 percent knew someone who already had," according to "Falling-Down Professions" in the Jan. 6, 2008, New York Times. The business side is strangling the professional calling.Take heart: Revenue might be lurking in your everyday coding and expenses. Try these tips to tap more charges and reduce losses.Tip 1. Code All Charges With Guru ReviewYou might be leaving money on the table if you rely on office staff who are unfamiliar with coverage policies to input your codes. "Pediatricians can capture revenue by having someone who knows the insurance plans review the charts and superbills daily to be sure that all charges have been captured," says Janet McDiarmid, CMM, CPC, MPC, of St. Petersburg Pediatrics, which has eight offices serving Pinellas County, Fla.The problem: When physicians mark superbills, many charges are missed, McDiarmid says. "The person doing the data entry is usually not a certified coder and does not have knowledge of what is covered and what is not."The reviewer should also make sure there is proper documentation for services rendered. "It is amazing the charges I capture by doing this analysis," she says.Myth: Think having a skilled reviewer is outside your budget? The position will likely more than pay for itself. McDiarmid captures significant dollars that the practice would have missed, and this "discovered" amount has easily paid for her salary. The role also ensures accurate coding, which would provide more protection in the event of an audit.Tip 2. Link Test to Correct ICD-9 CodeDenials could be heading your way, and the ticket to payment could be simply a digit away. Make sure that you assign the correct diagnosis to ancillary tests.Horror story: McDiarmid visited a practice where billers were very upset that insurers were denying their chest x-rays (71020, Radiologic examination, chest, two views, frontal and lateral). They had the correct CPT code, but they were using the diagnosis code for vaginal discharge (623.5, Leukorrhea, not specified as infective) instead of the x-ray sign or symptom (such as cough, 786.2) or diagnosis, costing them about $31.99 per denial (0.84 total RVUs x 38.0870 using the 2008 Medicare Physician Fee Schedule).Lesson learned: In pediatrics, payers are denying ancillary tests, such as strep tests, simply because "the ICD-9 code is not correctly assigned to the appropriate service," McDiarmid says. Double-check [...]