While medical billing is a time-consuming occupation that requires razor-sharp skill, the concept is quite simple. Tell your medical biller what you, the physician, did for the patient and why. When done correctly, payments for services rendered should be right around the corner. Because medical billers like us are not able to accompany you on every patient visit, we completely rely on the physician to provide the details. As a result, your input is vital in getting you paid on a timely, regular basis, provided that the medical biller is putting in your claims properly and on time.

 

When marking your superbill, you might feel a bit confused as to what code to choose, because you might not be sure what you have covered during that visit. You do not want to over-code, because if you are ever audited, it will cost you. On the other hand, you do not want to under-code, because in the long run your bottom line will suffer. Thousands of dollars will end up left on the table—and outside your practice. The physician should properly be compensated for services provided to patients. Please be aware that an astute medical biller is only as good as the information provided.

 

So how do you code correctly?

 

Let’s start by analyzing routine office visits, which will most commonly affect codes 99213 and 99214. Insurance companies pay more for a 99214 than a 99213. On average, there is a $30 difference between the two codes, depending on the insurance carrier. The simplest way to distinguish these two codes is to learn to differentiate between a low complexity and a moderate-to-high complexity medical issue. For example, if a gynecology visit requires the patient to remove any clothing for her examination, top or bottom, it is considered a 99214. If the patient remains dressed during the visit without a physical examination, such as a consult, it can be coded 99213. Both visits require time with the patient: therefore, each must be coded correctly to avoid shortchanging the physician or setting up red flags that may trigger an audit. Precise documentation during all visits is essential, especially since that is the only way to justify a higher level code.

 

Another way to find out whether you are picking the right numbers on your superbill is to compare yourself to fellow doctors nationwide. You can get comparative data from Medicare, which has published Evaluation and Management coding statistics by specialty for years. Keep in mind: these numbers are broader and deeper because they cover patients in various age groups, not just those eligible for Medicare. Profiling your own coding habits by asking your medical biller to generate a report listing for the frequency that certain codes have been used may ultimately boost your bottom line. It is a useful tool that may improve your coding skills. Most management software programs have this feature.

 

In the current climate of shrinking reimbursement and increasing overhead costs, providers cannot afford to leave potential revenue on the table. Before choosingyour routine visit code, pause for a moment and consider the level of medical decision-making required for the visit, including medical necessity, and let the intensity of the your labor guide your code selection. Make sure that your documentation is in agreement with that code.

 

You may be surprised how often 99214 is the appropriate choice.

 

Choosing the right code for every scenario will only help your bottom line. While a couple of dollars may not seem like much when reviewing one patient, it can add up to thousands over time when you multiply that small number by the overall times you use that same code—a code that reimburses less than that visit is worth, which a straight reflection of your worth. I am sure we can all agree you are worth more than that! 

 

 

Minerva DeJesus and Audi Reyes are founders of Simple Solution Billing in Maitland.