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Power Up Your Primary Care Coding by Nikki Taylor

Give your Primary Care coding a tune up! Get the inside scoop on the top billing and coding issues for Primary Care— Join Nikki Taylor, MBA, CPC®, COC™, CPMA®, CRC™, AAPC Fellow as she explores the hot topic of Primary Care coding including vaccines, counseling, telemedicine, and more. Plus—you’ll gain tips and resources to keep you one step ahead. Nikki will highlight what you need to know to ensure that you are not missing out on key revenue. During the webinar you’ll: 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 missteps Brush up on modifier 25 and preventative services coding Highlight helpful tools and resources to help ensure Primary Care coding success For Full PPT : https://www.supercoder.com/medical-coding-webinars/power-up-your-primary-care-coding

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supercoder
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135 views21 pages

Power Up Your Primary Care Coding by Nikki Taylor

Give your Primary Care coding a tune up! Get the inside scoop on the top billing and coding issues for Primary Care— Join Nikki Taylor, MBA, CPC®, COC™, CPMA®, CRC™, AAPC Fellow as she explores the hot topic of Primary Care coding including vaccines, counseling, telemedicine, and more. Plus—you’ll gain tips and resources to keep you one step ahead. Nikki will highlight what you need to know to ensure that you are not missing out on key revenue. During the webinar you’ll: 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 missteps Brush up on modifier 25 and preventative services coding Highlight helpful tools and resources to help ensure Primary Care coding success For Full PPT : https://www.supercoder.com/medical-coding-webinars/power-up-your-primary-care-coding

Uploaded by

supercoder
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Power Up Your Primary Care Coding

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


AAPC Fellow

1
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

2
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!

3
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

4
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
5
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

6
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

7
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

8
Know the Facts: Undercoding and Overcoding, cont.
Review of Systems

9
Know the Facts: Undercoding and Overcoding, cont.

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

10
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

11
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

12
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

17
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

18
Recap, cont.

• Helpful Tools and Resources


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

19
References

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

20
https://www.supercoder.com/medical-
coding-webinars/power-up-your-primary-
care-coding

56

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