Power Up Your Primary Care Coding

Speaker: Nikki Taylor, MBA, CPC®, COC™, CPMA®, CRC™,

AAPC Fellow

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Learning Objectives

• Nail down undercoding and overcoding mistakes and learn how to

prevent them
• Learn the ins and outs of telemedicine services and proper billing
• Eliminate counseling confusion and capture maximum revenue
• Sharpen your vaccination coding skills and learn how to avoid
common mis-steps
• Brush up on modifier 25 and preventative services coding
• Highlight helpful tools and resources to help ensure PrimaryCare
coding success

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Know the Facts: Undercoding and Overcoding

• Undercoding: Coding a service at a lower level than appropriate

• Overcoding: Coding a service at a higher level than appropriate
• Both are problematic!
• Creates incorrect utilization patterns
• Both may be considered a violation of fraud and abuse rules
• Do not play it safe byundercoding!

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Know the Facts: Undercoding and Overcoding, cont.

• Common with E/M coding, but can occur with anyservice

• Always select the most appropriatecode
• Know E/M guidelines and how to select servicelevels

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Know the Facts: Undercoding and Overcoding, cont.

• Three Key Components

• History
• HPI
• ROS
• PFSH
• Examination
• 1995 vs. 1997 Examination Guidelines
• Medical Decision Making
• Number of Diagnoses or TreatmentOptions
• Amount and/or Complexity of Data
• Risk of Complications and/or Morbidity orMortality
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Know the Facts: Undercoding and Overcoding, cont.

• History
• HPI: Description of Illness/Injury
• ROS: Review of Systems with Patient
• PFSH: Past Medical, Family, and Social History

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Know the Facts: Undercoding and Overcoding, cont.

• History of PresentIllness
• Must be documented by the provider
• 8 Elements of HPI
• Location: Chest pain
• QUALITY: Burning, dull
• SEVERITY: Better, 6 on a scale of 1-10
• DURATION: 1 week
• TIMING: Off and on, occasionally
• CONTEXT: After eating
• MODIFYING FACTORS: Took antacid
• ASSOCIATEDSIGNS/SYMPTOMS: Nausea and Vomiting, heartburn

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Know the Facts: Undercoding and Overcoding, cont.

• History of Present Illness

• 8 Elements of HPI
• Insufficient
• No Modifying Factors
• No Associated Signs or Symptoms
• Patient Not Sure-Duration of Symptoms
• Comprehensive Level = 4 or More HPI Elements

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Know the Facts: Undercoding and Overcoding, cont.
Review of Systems

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Know the Facts: Undercoding and Overcoding, cont.

• Past Medical:
• Patient’s past medical experiences
• Trauma
• Hospitalizations
• Illnesses
• Injuries
• Surgeries
• Current medications/Dietary status
• Allergies

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Know the Facts: Undercoding and Overcoding, cont.

• Family History
• Medical history of thepatient’s family
• Health / status of parents/siblings
• High risk of disease
• History related to the chief complaint, HPI orROS

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Know the Facts: Undercoding and Overcoding, cont.

• Social History:
• Past and current social history
• Education/Occupation
• Marital status
• Living Situation
• Present or history of drug, alcohol, or tobacco use

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Know the Facts: Undercoding and Overcoding, cont.

Level of History History of Present Review of Systems PFSH

Illness
Problem Focused Brief (1-3) N/A N/A
Expanded Problem Brief (1-3) Problem pertinent (1) N/A
Focused
Detailed Extended (4+) Extended (2-9) Pertinent (1)
Comprehensive Extended (4+) Complete (10+) Complete (ED=2)

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Recap

• Undercoding is just as bad as overcoding!

• Can be considered fraudulent and abusive billing practices
• Surgical and E/M can be overcoded or undercoded
• Telemedicine is beneficial to patients andproviders
• Know the rules

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Recap, cont.

• Don’t leave money on the table!

• Ensure no missed counseling and screening services
• Tighten up same day sick and preventative services
• Ensure accurate vaccine coding
• Remember modifier 25 guidelines

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Recap, cont.

• Helpful Tools and Resources

• SuperCoder.com
• CCIedits checker
• Code details for telemedicine codes
• Medicare fee schedules
• EMAuditor
• And more…

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References

• www.cms.gov
• www.supercoder.com
• AMA CPT®2018
• AMA Medical Record Auditor

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 https://www.supercoder.com/medical-
coding-webinars/power-up-your-primary-
care-coding

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