Family physicians often treat patients with multiple chronic diseases. For example, it isn't uncommon for a single patient to have obesity, diabetes, coronary artery disease and hypertension. Office visits for these more complicated patients necessitate higher levels of service -- and higher levels of coding.
Coding for Chronic Disease Care Presents Challenges, Opportunities
By Sheri Porter
If a physician addresses three chronic diseases in a single patient visit, it usually -- though not always -- merits a 99214 level CPT code, according to FP Thomas Felger, M.D., of Granger, Ind. Felger teaches coding to residents as part of the practice management curriculum at the St. Joseph Regional Medical Center Family Medicine Residency Program in South Bend, Ind.
Family physicians notoriously undervalue the services they provide, said Felger. It's not unusual for an FP to examine a complicated patient, prescribe six medications for three chronic diseases and then say, "Well, I didn't do very much for that patient" -- a perfect set-up for undercoding.
The key to receiving appropriate payment for services rendered is careful documentation, said Marie Felger, C.P.C., C.C.S.P. who sometimes teaches coding courses alongside her husband. She said that if a physician is treating three conditions during a visit, all three must be addressed throughout the documentation, even if that documentation just indicates the condition in question is stable.
"A treatment plan for each condition needs to be documented in the plan of care," Marie Felger cautioned, such as, "Continue exercise program for weight loss," or "Continue on asthma medication."
Equally important are the ICD-9 codes, said Thomas Felger. The last digit in the code gives the insurer added information about the diagnosis. For example, in a patient with diabetes, the final ICD-9 digit signals the type of diabetes for which the patient is being treated and whether the disease is controlled or not controlled. That information, in turn, communicates to the insurer how often the patient needs to be seen by the physician. "If the patient's disease is not controlled, you're probably going to see him back sooner," he said.
As for relying on electronic health record, or EHR, systems for easy and accurate coding, Thomas Felger stopped short of a total endorsement. An EHR can make the process easier, "but it can get kind of carried away with itself because it doesn't take into account how much work was done," he said. An EHR "just looks at data."
Family physicians notoriously undervalue the services they provide, said Felger. It's not unusual for an FP to examine a complicated patient, prescribe six medications for three chronic diseases and then say, "Well, I didn't do very much for that patient" -- a perfect set-up for undercoding.
The key to receiving appropriate payment for services rendered is careful documentation, said Marie Felger, C.P.C., C.C.S.P. who sometimes teaches coding courses alongside her husband. She said that if a physician is treating three conditions during a visit, all three must be addressed throughout the documentation, even if that documentation just indicates the condition in question is stable.
"A treatment plan for each condition needs to be documented in the plan of care," Marie Felger cautioned, such as, "Continue exercise program for weight loss," or "Continue on asthma medication."
Equally important are the ICD-9 codes, said Thomas Felger. The last digit in the code gives the insurer added information about the diagnosis. For example, in a patient with diabetes, the final ICD-9 digit signals the type of diabetes for which the patient is being treated and whether the disease is controlled or not controlled. That information, in turn, communicates to the insurer how often the patient needs to be seen by the physician. "If the patient's disease is not controlled, you're probably going to see him back sooner," he said.
As for relying on electronic health record, or EHR, systems for easy and accurate coding, Thomas Felger stopped short of a total endorsement. An EHR can make the process easier, "but it can get kind of carried away with itself because it doesn't take into account how much work was done," he said. An EHR "just looks at data."
Related ANN Coverage
Getting Paid for Your Work
Code Correctly, Document Diligently
(12/15/2005)
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Family Practice Management: Are you Prepared to Defend Your Coding?
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Getting Paid for Your Work
Code Correctly, Document Diligently
(12/15/2005)
More From AAFP
Family Practice Management: Are you Prepared to Defend Your Coding?
Practice Management: Coding Resources & Assistance
