Four Coding and Payment Opportunities You Might Be Missing
You're likely already doing the work, so why not get paid for it?
Fam Pract Manag. 2016 May-June;23(3):30-35.
Author disclosure: no relevant financial affiliations disclosed.
- 1. Bill for high-value services you've probably been providing for free
- 2. Perform wellness visits and, when appropriate, perform them with a problem-oriented visit on the same day
- 3. Identify missed ancillary charges and have a system for capturing them
- 4. Pay attention to your 99213s and 99214s
- “No dollar left behind”
In family medicine practices today, coding drives revenue. Even for employed physicians, coding drives compensation because it is a proxy for productivity. Although many practices are wisely preparing for value-based payment, physicians still need to optimize current revenue and compensation through correct coding. After all, 95 percent of all visits are still paid using fee for service.1
Unfortunately, many groups don't bother monitoring their coding patterns or optimizing their coding. They seem to believe that variation in levels of evaluation and management (E/M) service among physicians is unavoidable and beyond their control. It is not. Using a relatively simple but vital tool – a “CPT frequency report” – practices can identify coding patterns that result in lost revenue. (See “What is a CPT frequency report?”)
Differences in specialty and scope of practice result in some appropriate variation in E/M coding patterns. However, I recently reviewed the CPT frequency report of a multisite primary care group and found variation that had resulted in significant differences in their work relative value units (RVUs) per encounter and total revenue.
This article draws on that analysis to identify four often overlooked coding and revenue opportunities.
WHAT IS A CPT FREQUENCY REPORT?
A CPT frequency report, like the sample shown here, is simply a listing of all CPT codes billed by each physician for a given period, typically a year. The report lists the code, the code description, and the number of times it was billed. Physician leaders and managers can compile the report annually from the practice's billing system and get a snapshot of the group's coding patterns, without having to review individual charts and documentation. Although there will always be variation due to differences in practice patterns and patient populations, this tool can help reveal avoidable coding variances due to overcoding, undercoding, missed charges, or compliance issues.
For example, the report shows that Physician A reports code 99213 almost three times as often as code 99214, although the benchmark ratio is 1.08:1. There are no Medicare wellness visits or transitional care management services reported. There are no smoking cessation services or certification of home health services reported either. Nebulizer treatments are reported 16 times, but the medication for the nebulizer isn't billed. Influenza vaccinations are reported but no administration. New patient visits are billed at much higher levels than benchmarks.
Physician B has a ratio of 99213s to 99214s that is in line with the benchmark. This physician reports Medicare wellness visits and transitional care management services (both levels), as well as a few smoking cessation services. There are no home health certification services reported, however.
Benchmarks are derived from the Centers for Medicare & Medicaid Services, E/M Codes by Specialty, 2012. Available at: go
1. Zuvekas SH, Cohen JW. Fee-for-service, while much maligned, remains the dominant payment method for physician visits. Health Aff. 2016;35(3):411–414.
2. Benchmarks derived from Centers for Medicare & Medicaid Services, E&M Codes by Specialty, 2012. Available at: go.cms.gov/1Twbus7.
Copyright © 2016 by the American Academy of Family Physicians.
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