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efuhrmann

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Dear coders,
Does anyone have the secret to teach a doctor (in less than 15 minutes) the most important concepts in determining the level of E&M service he/she provided? I am being asked to "simplify" the process as much as possible and don't know how to go about it except to review the elements of an auditing tool. Can someone share how they educate these very busy providers?

Liz Fuhrmann CPC, BSN
 
More time

You need about an hour, maybe 45 minutes. 15 minutes isn't enough time. I understand they are busy BUT this affects, well IS, their revenue.

Education, education, education....:)
 
If they absolutely don't want or have time for "one on one" coding, I give my physicians "pocket coders". It's a laminated card, about the size of an index card. It has the "lay out" of the requirements for each level. Not my first preference but I understand your dilemma.
 
I have laminated cards I created as well. They seem to be helpful, at first, but they always get pushed aside eventually. and the cycle continues....:rolleyes:
 
I agree that this does happen. I'm one coder for over 35+ physicians/NPP's and multi-specialty on top of that. I always make time to sit with each provider and discuss regs/compliance/DG's, etc. If I see one deviating to the left or right, I try to put them back on course immediatley; however, you can only do so much. With that being said, now I perform chart reviews every 3 months. So, for those that suddenly forget last quarters information, I meet with them to conduct a "friendly reminder". But again, they have to take some initiative and R-E-A-D the information I provide. It's amazing to me how you can conduct a review, make a copy for them and they leave the meeting empty handed.
 
Give them real examples of the types of things you need to see in a note.

Example:
Patients had leg pain, mostly during evening hours, burning type pain that has been present for 2 weeks.

that is 2 sentences and has a complete HPI in it. The key is to teach them what to document vs how much.

Docs seem to think that they have to have a 6 page note and thats not the case so long as they use useful info in their notes.
 
Elizabeth,

If you're interested...

I ordered a "product" last week for E/M coding. Supposedly, it's one of the best E/M tools out there. The individual who created it is a genius...or so I think. I have one provider who is really struggling with the components for each level. If the information is out of site...the training is out of mind. Anyway...If your interested, I will PM you and let you know what I think about it when I receive it. :)
 
thanks for your messages everyone--yes, Rebecca I would be interested in your eval of the pocket reference. Like I think a lot of you, all is well until it comes time to explain decion making. And I don't care if I do it first or last, it's next to impossible to explain in one meeting. Every time I review the components I feel like apologizing and I'm not sure why...
 
LOL on the sorry note,

my famous line..... "I'm sorry, that's just the way it is" I probably say that 100 times!!!

and why are WE apologizing again????:rolleyes:
 
CPT element cheat sheet

One thing that made a HUGE difference is I made up a spreadsheet explaining all elements needed for codes. For example: a 99202 needs to have 1-3 HPI, a problem pertinent ROS, 2-4 organ system examination and a straight-forward MDM. (1995 guidelines). I spent some time educating the doctors on what HPI, ROS PFSH and MDM are and how to identify them in our EMR. Once they learned the basics, I saw an improvement in their documentation and coding. I have seen some physicians post this in every exam room as a reminder of what they need documented for codes. If you send me your email address I can send you the form.
I've found over time that doctors can have different styles of learning, just like students to. I have learned to communicate with different doctors in which ever way will benefit them the most.
Hope that helps!
 
Medical necessity

I'd say the first and more important thing a doctor needs to know is the MDM part of the documentation.

Doctors start their thought process with "what's wrong with the patient." And, generally, they have a "template" in their head of what they need to do to deal with the problem(s). Because of experience they already have a notion of the different kind of history that is needed, or what systems/body areas need to be examined for a "hernia" vs a "cold" vs "chest pain."

If you can show them the connection between these areas, and how it translates to the documentation required to arrive at the level of service, I think it helps the physicians internalize these processes.

I don't have a magic way of achieving this (especially not in 15 minutes). But we meet with our surgeons every other month and have 5-10 minutes on their agenda. We (my fellow reimbursement manager and I) try to focus on one area each time, rather than inundate them with everything. Next time we're going to mention the importance of -24 modifier for unrelated services during the global period.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
Explaining to Doctors E/M

I read the information in the thread and would be interested in any help to streamline the E/M explanation to physicians please. Thank you
 
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