FP Report -- April 1999
On the up-and-up
Earn more money for what you already do
For established patients with three or more chronic medical problems, if you take about 30 seconds longer for documentation, you'll raise your coding from 99213 to 99214.
That's a $15 difference.
"To me, taking a little extra time is well worth the $15," said Douglas Henley, M.D., of Fayetteville, N.C.
Henley, an AAFP past president, serves on the American Medical Association's Current Procedural Terminology Editorial Panel. It is advising the government on ways to streamline documentation guidelines for coding evaluation and management services.
But even under the 1997 documentation guidelines, said Henley, family doctors should typically code higher and receive more pay.
For example, when a child who had otitis media returns for an ear check, the visit would typically be coded as 99212. But after the ear exam, the mother or father might ask about a new problem the child has -- a rash, a sore big toe, whatever.
"If you document what you do to answer the 'Oh, by the way' question, the visit quickly becomes a 99213," said Henley.
That's an $11 difference.
"You aren't going to ignore the mother's question. So you take a little bit of extra history and do a little bit more examination, and you've met the test of a 99213," said Henley. "But most family doctors won't document that. They'll downcode themselves to a 99212 because to them, it's just a quick ear recheck, and that's the way they've always done it."
Perhaps they will change in 2000. New guidelines for coding evaluation and management services are expected to be implemented after next March. The 2000 guidelines will be simpler and easier to follow than the 1997 guidelines, said Henley.
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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