Physician billing tips to save precious dollars for your practice.
Not billing higher level E/M services because your physician glosses over a patient's past medical, family, and social history (PMFSH)? Well, you could be missing out on up to $69 per E/M if you are not doing so.
In order to ensure you're recognizing every history component the patient mentions, you need to heed these three key things: Determine the level of MPFSH, select a code based on PMFSH Element Requirement and count unchanged PMFSH in current encounter.
After you determine the level of PMFSH your physician documentation contains, you can see which codes that history element supports. Let's zoom in on this aspect:
Watch out: If your physician doesn't document any PMFSH elements, you can see which codes that history element supports. This means the highest codes you will be able to report are a level-two new patient code (99202) or a level-three established patient code (99213). Reporting 99202 will fetch you $71.01, while 99213 will bring in $68.97.
Relevant past medical, family, and social history supports a detailed history level; with detailed history you can report a level-three new patient code (99203) and a level-four established patient code. You will take home $102.95 for 99203 and $102.27 for 99214.
In order to get to level-four and five new patient visits and level-five established patient visits, you need to have an all-encompassing level of history. For that, you must determine complete PMFSH in your physician's documentation. If you can get 99204 or 99205, you will take home $158.33 (4.66 RVUs) and $197.06 (5.8 RVUs), in that order. You can anticipate $137.60 (4.05 RVUs) for 99215 – as much as $69 more than if you are obliged to code 99213 as you did not have adequate PMFSH.
Remember: As established patient office visits need two of three vital components, a higher level service is still possible based on the service's examination and medical decision making (MDM) types. For an established patient, you may decide to leave history off and count only the exam and MDM and then you have the low history. As such, if you have a weak history, you may still get to the higher level evaluation & management.
Not billing higher level E/M services because your physician glosses over a patient's past medical, family, and social history (PMFSH)? Well, you could be missing out on up to $69 per E/M if you are not doing so.
In order to ensure you're recognizing every history component the patient mentions, you need to heed these three key things: Determine the level of MPFSH, select a code based on PMFSH Element Requirement and count unchanged PMFSH in current encounter.
After you determine the level of PMFSH your physician documentation contains, you can see which codes that history element supports. Let's zoom in on this aspect:
Watch out: If your physician doesn't document any PMFSH elements, you can see which codes that history element supports. This means the highest codes you will be able to report are a level-two new patient code (99202) or a level-three established patient code (99213). Reporting 99202 will fetch you $71.01, while 99213 will bring in $68.97.
Relevant past medical, family, and social history supports a detailed history level; with detailed history you can report a level-three new patient code (99203) and a level-four established patient code. You will take home $102.95 for 99203 and $102.27 for 99214.
In order to get to level-four and five new patient visits and level-five established patient visits, you need to have an all-encompassing level of history. For that, you must determine complete PMFSH in your physician's documentation. If you can get 99204 or 99205, you will take home $158.33 (4.66 RVUs) and $197.06 (5.8 RVUs), in that order. You can anticipate $137.60 (4.05 RVUs) for 99215 – as much as $69 more than if you are obliged to code 99213 as you did not have adequate PMFSH.
Remember: As established patient office visits need two of three vital components, a higher level service is still possible based on the service's examination and medical decision making (MDM) types. For an established patient, you may decide to leave history off and count only the exam and MDM and then you have the low history. As such, if you have a weak history, you may still get to the higher level evaluation & management.
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