Re: 'Overcoding issues' / Disinfection?

January 30, 2006

You have to use autoclave for anything that makes a cut through skin.

You can use cidex for speculums, nasal speculums...but not for scalpels

etc.

The autoclave can't use a dry technique, the dry autoclaving is OK only

for some dental offices.

> Annie -

> As usual, great attitude. Using honesty and open-ness to defuse the

> issue

> before it builds. I think it's great advise.

>

> But, here's another issue... a few months ago, I think you were getting

> advise about disinfection in the office. Now I wonder if you've

> developed

> into an expert. And if not you, can others re-chime in.

>

> I was recently advised about disinfecting without autoclave in a small

> office. It was suggested to use standard cleaner, or, if contact with

> blood, use a special enzyme cleaner. Then place objects in Cidex

> solution.

> The cidex solution would need changing every 28 days.

>

> I've been considering using disposables as much as possible. But as

> with

> everything I'm reviewing all my choices and considering pros/cons in

> this

> last month.

> Thanks in advance (again)

> Tim

>

>> Hi Sue,

>> When I got one of those letters from Anthem, I immediately wrote and

>> invited them to come review charts and my code habits. I never heard

>> another word from them. I figured it would be easier to " entertain "

>> them early, when I had a small panel, than later when I was really

>> busy.

>> Just my 2 cents,

>> Annie

>>

>> " Overcoding issues "

>>

>> I have been following this group and have learned a lot. I appreciate

>> all of the advice! I have a question with which I would like some

>> help.

>>

>> I recently received a letter from one of our larger HMO's that said my

>> coding was above average for Family Medicine physicians, comparing

>> their

>> 2004 data to my 2005-as it related to 99214-15's. They said that they

>> are going to monitor my billing and, if that trend continues, they

>> will

>> be auditing my records.

>>

>> My initial thoughts-I know that many of us previously downcoded to

>> 13's

>> so as not to have to think or document, or to avoid just such

>> letters. I

>> also know that the " bell curve " is moving upward because we are now

>> becoming more proficient in coding, so the published data from even a

>> few years ago is not accurate now. I am just starting up (1.5 years in

>> this practice). I only have about 75 patients in my panel for this

>> particular group, and, in this short time frame, it has been mainly

>> the

>> more " sick " patients that are coming in. I am getting many chronically

>> ill patients with numerous problems, from our other ambulatory sites

>> (I

>> am hospital employed), and, although these pts. are new to me, I have

>> to

>> bill them as established because all of the sites have the same Tax

>> Id,

>> and these pts are all considered established. Needing to cover so many

>> issues at the " new " visit obviously results in many (mostly) 99214's.

>> Realistically, I feel that my panel is not large enough to have even

>> developed enough data for a " normal " bell curve, but I could be just

>> rationalizing all of this to support my data!

>>

>> My question-should I be pro active and contact the medical director of

>> this HMO who sent the letter to discuss this, find out the time frame

>> for their previous monitoring, and do my own audit of my charting? And

>> if my charting supports my billing pursue this to " prove " to them I am

>> coding appropriately (if my charts verify this)? Or should I not worry

>> about it, just be sure to focus particularly on this group to make

>> sure

>> I do things appropriately in the future. I hate to just let this go

>> because I feel they are sending out letters like this just to scare us

>> into downcoding. My best friend is the compliance officer for a nearby

>> hospital ambulatory care center, doing all of their auditing, and she

>> also works for a company that does just such audits nationwide. She

>> has

>> audited my charting previously, at my request, and tells me I am doing

>> things appropriately. But I hate to " tick off " this company and their

>> director and forever have the spotlight on my practice. By the way, I

>> do

>> not have EHR; we use only paper charts with hand written notes. I have

>> used the StatCoder program on my PDA and find that, according to that,

>> my coding is appropriate, although some issues like medical decision

>> making, can be somewhat grey areas.

>>

>> Any ideas would be appreciated.

>>

>> Sue

>>

>> _____

>>

>> YAHOO! GROUPS LINKS

>>

>> * Visit your group "

>> <http://groups.yahoo.com/group/> " on the web.

>>

>> *

January 30, 2006

Thanks. That's a good general rule to remember.

My actual sharps will be disposable (blades, punch biopsies, all needles)

but what about other tools used in open procedures that can have

blood/tissue contact, can I use cidex with them? Or is blood/tissue the

criteria for autoclaving?

Tim

> You have to use autoclave for anything that makes a cut through skin.

> You can use cidex for speculums, nasal speculums...but not for scalpels

> etc.

> The autoclave can't use a dry technique, the dry autoclaving is OK only

> for some dental offices.

>

>> Annie -

>> As usual, great attitude. Using honesty and open-ness to defuse the

>> issue

>> before it builds. I think it's great advise.

>>

>> But, here's another issue... a few months ago, I think you were

>> getting advise about disinfection in the office. Now I wonder if

>> you've developed

>> into an expert. And if not you, can others re-chime in.

>>

>> I was recently advised about disinfecting without autoclave in a small

>> office. It was suggested to use standard cleaner, or, if contact with

>> blood, use a special enzyme cleaner. Then place objects in Cidex

>> solution.

>> The cidex solution would need changing every 28 days.

>>

>> I've been considering using disposables as much as possible. But as

>> with

>> everything I'm reviewing all my choices and considering pros/cons in

>> this

>> last month.

>> Thanks in advance (again)

>> Tim

>>

>>> Hi Sue,

>>> When I got one of those letters from Anthem, I immediately wrote and

>>> invited them to come review charts and my code habits. I never heard

>>> another word from them. I figured it would be easier to " entertain "

>>> them early, when I had a small panel, than later when I was really

>>> busy.

>>> Just my 2 cents,

>>> Annie

>>>

>>> " Overcoding issues "

>>>

>>> I have been following this group and have learned a lot. I appreciate

>>> all of the advice! I have a question with which I would like some

>>> help.

>>>

>>> I recently received a letter from one of our larger HMO's that said

>>> my coding was above average for Family Medicine physicians, comparing

>>> their

>>> 2004 data to my 2005-as it related to 99214-15's. They said that they

>>> are going to monitor my billing and, if that trend continues, they

>>> will

>>> be auditing my records.

>>>

>>> My initial thoughts-I know that many of us previously downcoded to

>>> 13's

>>> so as not to have to think or document, or to avoid just such

>>> letters. I

>>> also know that the " bell curve " is moving upward because we are now

>>> becoming more proficient in coding, so the published data from even a

>>> few years ago is not accurate now. I am just starting up (1.5 years

>>> in this practice). I only have about 75 patients in my panel for this

>>> particular group, and, in this short time frame, it has been mainly

>>> the

>>> more " sick " patients that are coming in. I am getting many

>>> chronically ill patients with numerous problems, from our other

>>> ambulatory sites (I

>>> am hospital employed), and, although these pts. are new to me, I have

>>> to

>>> bill them as established because all of the sites have the same Tax

>>> Id,

>>> and these pts are all considered established. Needing to cover so

>>> many issues at the " new " visit obviously results in many (mostly)

>>> 99214's. Realistically, I feel that my panel is not large enough to

>>> have even developed enough data for a " normal " bell curve, but I

>>> could be just rationalizing all of this to support my data!

>>>

>>> My question-should I be pro active and contact the medical director

>>> of this HMO who sent the letter to discuss this, find out the time

>>> frame for their previous monitoring, and do my own audit of my

>>> charting? And if my charting supports my billing pursue this to

>>> " prove " to them I am coding appropriately (if my charts verify this)?

>>> Or should I not worry about it, just be sure to focus particularly on

>>> this group to make sure

>>> I do things appropriately in the future. I hate to just let this go

>>> because I feel they are sending out letters like this just to scare

>>> us into downcoding. My best friend is the compliance officer for a

>>> nearby hospital ambulatory care center, doing all of their auditing,

>>> and she also works for a company that does just such audits

>>> nationwide. She has

>>> audited my charting previously, at my request, and tells me I am

>>> doing things appropriately. But I hate to " tick off " this company and

>>> their director and forever have the spotlight on my practice. By the

>>> way, I do

>>> not have EHR; we use only paper charts with hand written notes. I

>>> have used the StatCoder program on my PDA and find that, according to

>>> that, my coding is appropriate, although some issues like medical

>>> decision making, can be somewhat grey areas.

>>>

>>> Any ideas would be appreciated.

>>>

>>> Sue

>>>

>>> _____

>>>

>>> YAHOO! GROUPS LINKS

>>>

>>> * Visit your group "

>>> <http://groups.yahoo.com/group/> " on the web.

>>>

>>> *

January 30, 2006

Thanks. That's a good general rule to remember.

My actual sharps will be disposable (blades, punch biopsies, all needles)

but what about other tools used in open procedures that can have

blood/tissue contact, can I use cidex with them? Or is blood/tissue the

criteria for autoclaving?

Tim

> You have to use autoclave for anything that makes a cut through skin.

> You can use cidex for speculums, nasal speculums...but not for scalpels

> etc.

> The autoclave can't use a dry technique, the dry autoclaving is OK only

> for some dental offices.

>

>> Annie -

>> As usual, great attitude. Using honesty and open-ness to defuse the

>> issue

>> before it builds. I think it's great advise.

>>

>> But, here's another issue... a few months ago, I think you were

>> getting advise about disinfection in the office. Now I wonder if

>> you've developed

>> into an expert. And if not you, can others re-chime in.

>>

>> I was recently advised about disinfecting without autoclave in a small

>> office. It was suggested to use standard cleaner, or, if contact with

>> blood, use a special enzyme cleaner. Then place objects in Cidex

>> solution.

>> The cidex solution would need changing every 28 days.

>>

>> I've been considering using disposables as much as possible. But as

>> with

>> everything I'm reviewing all my choices and considering pros/cons in

>> this

>> last month.

>> Thanks in advance (again)

>> Tim

>>

>>> Hi Sue,

>>> When I got one of those letters from Anthem, I immediately wrote and

>>> invited them to come review charts and my code habits. I never heard

>>> another word from them. I figured it would be easier to " entertain "

>>> them early, when I had a small panel, than later when I was really

>>> busy.

>>> Just my 2 cents,

>>> Annie

>>>

>>> " Overcoding issues "

>>>

>>> I have been following this group and have learned a lot. I appreciate

>>> all of the advice! I have a question with which I would like some

>>> help.

>>>

>>> I recently received a letter from one of our larger HMO's that said

>>> my coding was above average for Family Medicine physicians, comparing

>>> their

>>> 2004 data to my 2005-as it related to 99214-15's. They said that they

>>> are going to monitor my billing and, if that trend continues, they

>>> will

>>> be auditing my records.

>>>

>>> My initial thoughts-I know that many of us previously downcoded to

>>> 13's

>>> so as not to have to think or document, or to avoid just such

>>> letters. I

>>> also know that the " bell curve " is moving upward because we are now

>>> becoming more proficient in coding, so the published data from even a

>>> few years ago is not accurate now. I am just starting up (1.5 years

>>> in this practice). I only have about 75 patients in my panel for this

>>> particular group, and, in this short time frame, it has been mainly

>>> the

>>> more " sick " patients that are coming in. I am getting many

>>> chronically ill patients with numerous problems, from our other

>>> ambulatory sites (I

>>> am hospital employed), and, although these pts. are new to me, I have

>>> to

>>> bill them as established because all of the sites have the same Tax

>>> Id,

>>> and these pts are all considered established. Needing to cover so

>>> many issues at the " new " visit obviously results in many (mostly)

>>> 99214's. Realistically, I feel that my panel is not large enough to

>>> have even developed enough data for a " normal " bell curve, but I

>>> could be just rationalizing all of this to support my data!

>>>

>>> My question-should I be pro active and contact the medical director

>>> of this HMO who sent the letter to discuss this, find out the time

>>> frame for their previous monitoring, and do my own audit of my

>>> charting? And if my charting supports my billing pursue this to

>>> " prove " to them I am coding appropriately (if my charts verify this)?

>>> Or should I not worry about it, just be sure to focus particularly on

>>> this group to make sure

>>> I do things appropriately in the future. I hate to just let this go

>>> because I feel they are sending out letters like this just to scare

>>> us into downcoding. My best friend is the compliance officer for a

>>> nearby hospital ambulatory care center, doing all of their auditing,

>>> and she also works for a company that does just such audits

>>> nationwide. She has

>>> audited my charting previously, at my request, and tells me I am

>>> doing things appropriately. But I hate to " tick off " this company and

>>> their director and forever have the spotlight on my practice. By the

>>> way, I do

>>> not have EHR; we use only paper charts with hand written notes. I

>>> have used the StatCoder program on my PDA and find that, according to

>>> that, my coding is appropriate, although some issues like medical

>>> decision making, can be somewhat grey areas.

>>>

>>> Any ideas would be appreciated.

>>>

>>> Sue

>>>

>>> _____

>>>

>>> YAHOO! GROUPS LINKS

>>>

>>> * Visit your group "

>>> <http://groups.yahoo.com/group/> " on the web.

>>>

>>> *

January 30, 2006

I only use disposables for cutting skin:

scalpels, biopsy punches. But I don’t buy “trays”—WAY too

expensive.

Annie

" Overcoding issues "

>>

>> I have been following this group and have

learned a lot. I appreciate

>> all of the advice! I have a question with

which I would like some

>> help.

>>

>> I recently received a letter from one of

our larger HMO's that said my

>> coding was above average for Family

Medicine physicians, comparing

>> their

>> 2004 data to my 2005-as it related to

99214-15's. They said that they

>> are going to monitor my billing and, if

that trend continues, they

>> will

>> be auditing my records.

>>

>> My initial thoughts-I know that many of

us previously downcoded to

>> 13's

>> so as not to have to think or document,

or to avoid just such

>> letters. I

>> also know that the " bell curve "

is moving upward because we are now

>> becoming more proficient in coding, so

the published data from even a

>> few years ago is not accurate now. I am

just starting up (1.5 years in

>> this practice). I only have about 75

patients in my panel for this

>> particular group, and, in this short time

frame, it has been mainly

>> the

>> more " sick " patients that are

coming in. I am getting many chronically

>> ill patients with numerous problems, from

our other ambulatory sites

>> (I

>> am hospital employed), and, although

these pts. are new to me, I have

>> to

>> bill them as established because all of

the sites have the same Tax

>> Id,

>> and these pts are all considered

established. Needing to cover so many

>> issues at the " new " visit

obviously results in many (mostly) 99214's.

>> Realistically, I feel that my panel is

not large enough to have even

>> developed enough data for a

" normal " bell curve, but I could be just

>> rationalizing all of this to support my

data!

>>

>> My question-should I be pro active and

contact the medical director of

>> this HMO who sent the letter to discuss

this, find out the time frame

>> for their previous monitoring, and do my

own audit of my charting? And

>> if my charting supports my billing pursue

this to " prove " to them I am

>> coding appropriately (if my charts verify

this)? Or should I not worry

>> about it, just be sure to focus

particularly on this group to make

>> sure

>> I do things appropriately in the future.

I hate to just let this go

>> because I feel they are sending out

letters like this just to scare us

>> into downcoding. My best friend is the

compliance officer for a nearby

>> hospital ambulatory care center, doing

all of their auditing, and she

>> also works for a company that does just

such audits nationwide. She

>> has

>> audited my charting previously, at my

request, and tells me I am doing

>> things appropriately. But I hate to

" tick off " this company and their

>> director and forever have the spotlight

on my practice. By the way, I

>> do

>> not have EHR; we use only paper charts

with hand written notes. I have

>> used the StatCoder program on my PDA and

find that, according to that,

>> my coding is appropriate, although some

issues like medical decision

>> making, can be somewhat grey areas.

>>

>> Any ideas would be appreciated.

>>

>> Sue

>>

>> _____

>>

>> YAHOO! GROUPS LINKS

>>

* Visit your group

"

>> <http://groups.yahoo.com/group/>

" on the web.

>>

*

January 30, 2006

I only use disposables for cutting skin:

scalpels, biopsy punches. But I don’t buy “trays”—WAY too

expensive.

Annie

" Overcoding issues "

>>

>> I have been following this group and have

learned a lot. I appreciate

>> all of the advice! I have a question with

which I would like some

>> help.

>>

>> I recently received a letter from one of

our larger HMO's that said my

>> coding was above average for Family

Medicine physicians, comparing

>> their

>> 2004 data to my 2005-as it related to

99214-15's. They said that they

>> are going to monitor my billing and, if

that trend continues, they

>> will

>> be auditing my records.

>>

>> My initial thoughts-I know that many of

us previously downcoded to

>> 13's

>> so as not to have to think or document,

or to avoid just such

>> letters. I

>> also know that the " bell curve "

is moving upward because we are now

>> becoming more proficient in coding, so

the published data from even a

>> few years ago is not accurate now. I am

just starting up (1.5 years in

>> this practice). I only have about 75

patients in my panel for this

>> particular group, and, in this short time

frame, it has been mainly

>> the

>> more " sick " patients that are

coming in. I am getting many chronically

>> ill patients with numerous problems, from

our other ambulatory sites

>> (I

>> am hospital employed), and, although

these pts. are new to me, I have

>> to

>> bill them as established because all of

the sites have the same Tax

>> Id,

>> and these pts are all considered

established. Needing to cover so many

>> issues at the " new " visit

obviously results in many (mostly) 99214's.

>> Realistically, I feel that my panel is

not large enough to have even

>> developed enough data for a

" normal " bell curve, but I could be just

>> rationalizing all of this to support my

data!

>>

>> My question-should I be pro active and

contact the medical director of

>> this HMO who sent the letter to discuss

this, find out the time frame

>> for their previous monitoring, and do my

own audit of my charting? And

>> if my charting supports my billing pursue

this to " prove " to them I am

>> coding appropriately (if my charts verify

this)? Or should I not worry

>> about it, just be sure to focus

particularly on this group to make

>> sure

>> I do things appropriately in the future.

I hate to just let this go

>> because I feel they are sending out

letters like this just to scare us

>> into downcoding. My best friend is the

compliance officer for a nearby

>> hospital ambulatory care center, doing

all of their auditing, and she

>> also works for a company that does just

such audits nationwide. She

>> has

>> audited my charting previously, at my

request, and tells me I am doing

>> things appropriately. But I hate to

" tick off " this company and their

>> director and forever have the spotlight

on my practice. By the way, I

>> do

>> not have EHR; we use only paper charts

with hand written notes. I have

>> used the StatCoder program on my PDA and

find that, according to that,

>> my coding is appropriate, although some

issues like medical decision

>> making, can be somewhat grey areas.

>>

>> Any ideas would be appreciated.

>>

>> Sue

>>

>> _____

>>

>> YAHOO! GROUPS LINKS

>>

* Visit your group

"

>> <http://groups.yahoo.com/group/>

" on the web.

>>

*

January 30, 2006

You have to autoclave those too. You wash them with a brush and water

and then autoclave them. You have to run a spores test once a month.

> Thanks. That's a good general rule to remember.

>

> My actual sharps will be disposable (blades, punch biopsies, all

> needles)

> but what about other tools used in open procedures that can have

> blood/tissue contact, can I use cidex with them? Or is blood/tissue the

> criteria for autoclaving?

> Tim

>

>> You have to use autoclave for anything that makes a cut through skin.

>> You can use cidex for speculums, nasal speculums...but not for

>> scalpels

>> etc.

>> The autoclave can't use a dry technique, the dry autoclaving is OK

>> only

>> for some dental offices.

>>

>>> Annie -

>>> As usual, great attitude. Using honesty and open-ness to defuse the

>>> issue

>>> before it builds. I think it's great advise.

>>>

>>> But, here's another issue... a few months ago, I think you were

>>> getting advise about disinfection in the office. Now I wonder if

>>> you've developed

>>> into an expert. And if not you, can others re-chime in.

>>>

>>> I was recently advised about disinfecting without autoclave in a

>>> small

>>> office. It was suggested to use standard cleaner, or, if contact

>>> with

>>> blood, use a special enzyme cleaner. Then place objects in Cidex

>>> solution.

>>> The cidex solution would need changing every 28 days.

>>>

>>> I've been considering using disposables as much as possible. But as

>>> with

>>> everything I'm reviewing all my choices and considering pros/cons in

>>> this

>>> last month.

>>> Thanks in advance (again)

>>> Tim

>>>

>>>> Hi Sue,

>>>> When I got one of those letters from Anthem, I immediately wrote and

>>>> invited them to come review charts and my code habits. I never

>>>> heard

>>>> another word from them. I figured it would be easier to " entertain "

>>>> them early, when I had a small panel, than later when I was really

>>>> busy.

>>>> Just my 2 cents,

>>>> Annie

>>>>

>>>> " Overcoding issues "

>>>>

>>>> I have been following this group and have learned a lot. I

>>>> appreciate

>>>> all of the advice! I have a question with which I would like some

>>>> help.

>>>>

>>>> I recently received a letter from one of our larger HMO's that said

>>>> my coding was above average for Family Medicine physicians,

>>>> comparing

>>>> their

>>>> 2004 data to my 2005-as it related to 99214-15's. They said that

>>>> they

>>>> are going to monitor my billing and, if that trend continues, they

>>>> will

>>>> be auditing my records.

>>>>

>>>> My initial thoughts-I know that many of us previously downcoded to

>>>> 13's

>>>> so as not to have to think or document, or to avoid just such

>>>> letters. I

>>>> also know that the " bell curve " is moving upward because we are now

>>>> becoming more proficient in coding, so the published data from even

>>>> a

>>>> few years ago is not accurate now. I am just starting up (1.5 years

>>>> in this practice). I only have about 75 patients in my panel for

>>>> this

>>>> particular group, and, in this short time frame, it has been mainly

>>>> the

>>>> more " sick " patients that are coming in. I am getting many

>>>> chronically ill patients with numerous problems, from our other

>>>> ambulatory sites (I

>>>> am hospital employed), and, although these pts. are new to me, I

>>>> have

>>>> to

>>>> bill them as established because all of the sites have the same Tax

>>>> Id,

>>>> and these pts are all considered established. Needing to cover so

>>>> many issues at the " new " visit obviously results in many (mostly)

>>>> 99214's. Realistically, I feel that my panel is not large enough to

>>>> have even developed enough data for a " normal " bell curve, but I

>>>> could be just rationalizing all of this to support my data!

>>>>

>>>> My question-should I be pro active and contact the medical director

>>>> of this HMO who sent the letter to discuss this, find out the time

>>>> frame for their previous monitoring, and do my own audit of my

>>>> charting? And if my charting supports my billing pursue this to

>>>> " prove " to them I am coding appropriately (if my charts verify

>>>> this)?

>>>> Or should I not worry about it, just be sure to focus particularly

>>>> on

>>>> this group to make sure

>>>> I do things appropriately in the future. I hate to just let this go

>>>> because I feel they are sending out letters like this just to scare

>>>> us into downcoding. My best friend is the compliance officer for a

>>>> nearby hospital ambulatory care center, doing all of their auditing,

>>>> and she also works for a company that does just such audits

>>>> nationwide. She has

>>>> audited my charting previously, at my request, and tells me I am

>>>> doing things appropriately. But I hate to " tick off " this company

>>>> and

>>>> their director and forever have the spotlight on my practice. By the

>>>> way, I do

>>>> not have EHR; we use only paper charts with hand written notes. I

>>>> have used the StatCoder program on my PDA and find that, according

>>>> to

>>>> that, my coding is appropriate, although some issues like medical

>>>> decision making, can be somewhat grey areas.

>>>>

>>>> Any ideas would be appreciated.

>>>>

>>>> Sue

>>>>

>>>> _____

>>>>

>>>> YAHOO! GROUPS LINKS

>>>>

>>>> * Visit your group "

>>>> <http://groups.yahoo.com/group/> " on the web.

>>>>

>>>> *

January 30, 2006

You have to autoclave those too. You wash them with a brush and water

and then autoclave them. You have to run a spores test once a month.

> Thanks. That's a good general rule to remember.

>

> My actual sharps will be disposable (blades, punch biopsies, all

> needles)

> but what about other tools used in open procedures that can have

> blood/tissue contact, can I use cidex with them? Or is blood/tissue the

> criteria for autoclaving?

> Tim

>

>> You have to use autoclave for anything that makes a cut through skin.

>> You can use cidex for speculums, nasal speculums...but not for

>> scalpels

>> etc.

>> The autoclave can't use a dry technique, the dry autoclaving is OK

>> only

>> for some dental offices.

>>

>>> Annie -

>>> As usual, great attitude. Using honesty and open-ness to defuse the

>>> issue

>>> before it builds. I think it's great advise.

>>>

>>> But, here's another issue... a few months ago, I think you were

>>> getting advise about disinfection in the office. Now I wonder if

>>> you've developed

>>> into an expert. And if not you, can others re-chime in.

>>>

>>> I was recently advised about disinfecting without autoclave in a

>>> small

>>> office. It was suggested to use standard cleaner, or, if contact

>>> with

>>> blood, use a special enzyme cleaner. Then place objects in Cidex

>>> solution.

>>> The cidex solution would need changing every 28 days.

>>>

>>> I've been considering using disposables as much as possible. But as

>>> with

>>> everything I'm reviewing all my choices and considering pros/cons in

>>> this

>>> last month.

>>> Thanks in advance (again)

>>> Tim

>>>

>>>> Hi Sue,

>>>> When I got one of those letters from Anthem, I immediately wrote and

>>>> invited them to come review charts and my code habits. I never

>>>> heard

>>>> another word from them. I figured it would be easier to " entertain "

>>>> them early, when I had a small panel, than later when I was really

>>>> busy.

>>>> Just my 2 cents,

>>>> Annie

>>>>

>>>> " Overcoding issues "

>>>>

>>>> I have been following this group and have learned a lot. I

>>>> appreciate

>>>> all of the advice! I have a question with which I would like some

>>>> help.

>>>>

>>>> I recently received a letter from one of our larger HMO's that said

>>>> my coding was above average for Family Medicine physicians,

>>>> comparing

>>>> their

>>>> 2004 data to my 2005-as it related to 99214-15's. They said that

>>>> they

>>>> are going to monitor my billing and, if that trend continues, they

>>>> will

>>>> be auditing my records.

>>>>

>>>> My initial thoughts-I know that many of us previously downcoded to

>>>> 13's

>>>> so as not to have to think or document, or to avoid just such

>>>> letters. I

>>>> also know that the " bell curve " is moving upward because we are now

>>>> becoming more proficient in coding, so the published data from even

>>>> a

>>>> few years ago is not accurate now. I am just starting up (1.5 years

>>>> in this practice). I only have about 75 patients in my panel for

>>>> this

>>>> particular group, and, in this short time frame, it has been mainly

>>>> the

>>>> more " sick " patients that are coming in. I am getting many

>>>> chronically ill patients with numerous problems, from our other

>>>> ambulatory sites (I

>>>> am hospital employed), and, although these pts. are new to me, I

>>>> have

>>>> to

>>>> bill them as established because all of the sites have the same Tax

>>>> Id,

>>>> and these pts are all considered established. Needing to cover so

>>>> many issues at the " new " visit obviously results in many (mostly)

>>>> 99214's. Realistically, I feel that my panel is not large enough to

>>>> have even developed enough data for a " normal " bell curve, but I

>>>> could be just rationalizing all of this to support my data!

>>>>

>>>> My question-should I be pro active and contact the medical director

>>>> of this HMO who sent the letter to discuss this, find out the time

>>>> frame for their previous monitoring, and do my own audit of my

>>>> charting? And if my charting supports my billing pursue this to

>>>> " prove " to them I am coding appropriately (if my charts verify

>>>> this)?

>>>> Or should I not worry about it, just be sure to focus particularly

>>>> on

>>>> this group to make sure

>>>> I do things appropriately in the future. I hate to just let this go

>>>> because I feel they are sending out letters like this just to scare

>>>> us into downcoding. My best friend is the compliance officer for a

>>>> nearby hospital ambulatory care center, doing all of their auditing,

>>>> and she also works for a company that does just such audits

>>>> nationwide. She has

>>>> audited my charting previously, at my request, and tells me I am

>>>> doing things appropriately. But I hate to " tick off " this company

>>>> and

>>>> their director and forever have the spotlight on my practice. By the

>>>> way, I do

>>>> not have EHR; we use only paper charts with hand written notes. I

>>>> have used the StatCoder program on my PDA and find that, according

>>>> to

>>>> that, my coding is appropriate, although some issues like medical

>>>> decision making, can be somewhat grey areas.

>>>>

>>>> Any ideas would be appreciated.

>>>>

>>>> Sue

>>>>

>>>> _____

>>>>

>>>> YAHOO! GROUPS LINKS

>>>>

>>>> * Visit your group "

>>>> <http://groups.yahoo.com/group/> " on the web.

>>>>

>>>> *

January 30, 2006

Interesting. So the enzymatic cleaner I was being suggested to use isn't

sufficient?

Thanks for the pointers.

Tim

> You have to autoclave those too. You wash them with a brush and water

> and then autoclave them. You have to run a spores test once a month. On

> Jan 29, 2006, at 10:22 PM, Malia, MD wrote:

>

>> Thanks. That's a good general rule to remember.

>>

>> My actual sharps will be disposable (blades, punch biopsies, all

>> needles)

>> but what about other tools used in open procedures that can have

>> blood/tissue contact, can I use cidex with them? Or is blood/tissue

>> the criteria for autoclaving?

>> Tim

>>

>>> You have to use autoclave for anything that makes a cut through skin.

>>> You can use cidex for speculums, nasal speculums...but not for

>>> scalpels

>>> etc.

>>> The autoclave can't use a dry technique, the dry autoclaving is OK

>>> only

>>> for some dental offices.

>>>

>>>> Annie -

>>>> As usual, great attitude. Using honesty and open-ness to defuse the

>>>> issue

>>>> before it builds. I think it's great advise.

>>>>

>>>> But, here's another issue... a few months ago, I think you were

>>>> getting advise about disinfection in the office. Now I wonder if

>>>> you've developed

>>>> into an expert. And if not you, can others re-chime in.

>>>>

>>>> I was recently advised about disinfecting without autoclave in a

>>>> small

>>>> office. It was suggested to use standard cleaner, or, if contact

>>>> with

>>>> blood, use a special enzyme cleaner. Then place objects in Cidex

>>>> solution.

>>>> The cidex solution would need changing every 28 days.

>>>>

>>>> I've been considering using disposables as much as possible. But as

>>>> with

>>>> everything I'm reviewing all my choices and considering pros/cons in

>>>> this

>>>> last month.

>>>> Thanks in advance (again)

>>>> Tim

>>>>

>>>>> Hi Sue,

>>>>> When I got one of those letters from Anthem, I immediately wrote

>>>>> and invited them to come review charts and my code habits. I never

>>>>> heard

>>>>> another word from them. I figured it would be easier to

>>>>> " entertain " them early, when I had a small panel, than later when I

>>>>> was really busy.

>>>>> Just my 2 cents,

>>>>> Annie

>>>>>

>>>>> " Overcoding issues "

>>>>>

>>>>> I have been following this group and have learned a lot. I

>>>>> appreciate

>>>>> all of the advice! I have a question with which I would like some

>>>>> help.

>>>>>

>>>>> I recently received a letter from one of our larger HMO's that said

>>>>> my coding was above average for Family Medicine physicians,

>>>>> comparing

>>>>> their

>>>>> 2004 data to my 2005-as it related to 99214-15's. They said that

>>>>> they

>>>>> are going to monitor my billing and, if that trend continues, they

>>>>> will

>>>>> be auditing my records.

>>>>>

>>>>> My initial thoughts-I know that many of us previously downcoded to

>>>>> 13's

>>>>> so as not to have to think or document, or to avoid just such

>>>>> letters. I

>>>>> also know that the " bell curve " is moving upward because we are now

>>>>> becoming more proficient in coding, so the published data from even

>>>>> a

>>>>> few years ago is not accurate now. I am just starting up (1.5 years

>>>>> in this practice). I only have about 75 patients in my panel for

>>>>> this

>>>>> particular group, and, in this short time frame, it has been mainly

>>>>> the

>>>>> more " sick " patients that are coming in. I am getting many

>>>>> chronically ill patients with numerous problems, from our other

>>>>> ambulatory sites (I

>>>>> am hospital employed), and, although these pts. are new to me, I

>>>>> have

>>>>> to

>>>>> bill them as established because all of the sites have the same Tax

>>>>> Id,

>>>>> and these pts are all considered established. Needing to cover so

>>>>> many issues at the " new " visit obviously results in many (mostly)

>>>>> 99214's. Realistically, I feel that my panel is not large enough to

>>>>> have even developed enough data for a " normal " bell curve, but I

>>>>> could be just rationalizing all of this to support my data!

>>>>>

>>>>> My question-should I be pro active and contact the medical director

>>>>> of this HMO who sent the letter to discuss this, find out the time

>>>>> frame for their previous monitoring, and do my own audit of my

>>>>> charting? And if my charting supports my billing pursue this to

>>>>> " prove " to them I am coding appropriately (if my charts verify

>>>>> this)?

>>>>> Or should I not worry about it, just be sure to focus particularly

>>>>> on

>>>>> this group to make sure

>>>>> I do things appropriately in the future. I hate to just let this go

>>>>> because I feel they are sending out letters like this just to scare

>>>>> us into downcoding. My best friend is the compliance officer for a

>>>>> nearby hospital ambulatory care center, doing all of their

>>>>> auditing, and she also works for a company that does just such

>>>>> audits

>>>>> nationwide. She has

>>>>> audited my charting previously, at my request, and tells me I am

>>>>> doing things appropriately. But I hate to " tick off " this company

>>>>> and

>>>>> their director and forever have the spotlight on my practice. By

>>>>> the way, I do

>>>>> not have EHR; we use only paper charts with hand written notes. I

>>>>> have used the StatCoder program on my PDA and find that, according

>>>>> to

>>>>> that, my coding is appropriate, although some issues like medical

>>>>> decision making, can be somewhat grey areas.

>>>>>

>>>>> Any ideas would be appreciated.

>>>>>

>>>>> Sue

>>>>>

>>>>> _____

>>>>>

>>>>> YAHOO! GROUPS LINKS

>>>>>

>>>>> * Visit your group "

>>>>> <http://groups.yahoo.com/group/> " on the web.

>>>>>

>>>>> *

January 30, 2006

See here

http://www.aafp.org/afp/20010215/practice.html

there is a difference between sterilization and high-level disinfection.

> Interesting. So the enzymatic cleaner I was being suggested to use

> isn't

> sufficient?

>

> Thanks for the pointers.

> Tim

>

>> You have to autoclave those too. You wash them with a brush and water

>> and then autoclave them. You have to run a spores test once a month.

>> On

>> Jan 29, 2006, at 10:22 PM, Malia, MD wrote:

>>

>>> Thanks. That's a good general rule to remember.

>>>

>>> My actual sharps will be disposable (blades, punch biopsies, all

>>> needles)

>>> but what about other tools used in open procedures that can have

>>> blood/tissue contact, can I use cidex with them? Or is blood/tissue

>>> the criteria for autoclaving?

>>> Tim

>>>

>>>> You have to use autoclave for anything that makes a cut through

>>>> skin.

>>>> You can use cidex for speculums, nasal speculums...but not for

>>>> scalpels

>>>> etc.

>>>> The autoclave can't use a dry technique, the dry autoclaving is OK

>>>> only

>>>> for some dental offices.

>>>>

>>>>> Annie -

>>>>> As usual, great attitude. Using honesty and open-ness to defuse the

>>>>> issue

>>>>> before it builds. I think it's great advise.

>>>>>

>>>>> But, here's another issue... a few months ago, I think you were

>>>>> getting advise about disinfection in the office. Now I wonder if

>>>>> you've developed

>>>>> into an expert. And if not you, can others re-chime in.

>>>>>

>>>>> I was recently advised about disinfecting without autoclave in a

>>>>> small

>>>>> office. It was suggested to use standard cleaner, or, if contact

>>>>> with

>>>>> blood, use a special enzyme cleaner. Then place objects in Cidex

>>>>> solution.

>>>>> The cidex solution would need changing every 28 days.

>>>>>

>>>>> I've been considering using disposables as much as possible. But as

>>>>> with

>>>>> everything I'm reviewing all my choices and considering pros/cons

>>>>> in

>>>>> this

>>>>> last month.

>>>>> Thanks in advance (again)

>>>>> Tim

>>>>>

>>>>>> Hi Sue,

>>>>>> When I got one of those letters from Anthem, I immediately wrote

>>>>>> and invited them to come review charts and my code habits. I

>>>>>> never

>>>>>> heard

>>>>>> another word from them. I figured it would be easier to

>>>>>> " entertain " them early, when I had a small panel, than later when

>>>>>> I

>>>>>> was really busy.

>>>>>> Just my 2 cents,

>>>>>> Annie

>>>>>>

>>>>>> " Overcoding issues "

>>>>>>

>>>>>> I have been following this group and have learned a lot. I

>>>>>> appreciate

>>>>>> all of the advice! I have a question with which I would like some

>>>>>> help.

>>>>>>

>>>>>> I recently received a letter from one of our larger HMO's that

>>>>>> said

>>>>>> my coding was above average for Family Medicine physicians,

>>>>>> comparing

>>>>>> their

>>>>>> 2004 data to my 2005-as it related to 99214-15's. They said that

>>>>>> they

>>>>>> are going to monitor my billing and, if that trend continues, they

>>>>>> will

>>>>>> be auditing my records.

>>>>>>

>>>>>> My initial thoughts-I know that many of us previously downcoded to

>>>>>> 13's

>>>>>> so as not to have to think or document, or to avoid just such

>>>>>> letters. I

>>>>>> also know that the " bell curve " is moving upward because we are

>>>>>> now

>>>>>> becoming more proficient in coding, so the published data from

>>>>>> even

>>>>>> a

>>>>>> few years ago is not accurate now. I am just starting up (1.5

>>>>>> years

>>>>>> in this practice). I only have about 75 patients in my panel for

>>>>>> this

>>>>>> particular group, and, in this short time frame, it has been

>>>>>> mainly

>>>>>> the

>>>>>> more " sick " patients that are coming in. I am getting many

>>>>>> chronically ill patients with numerous problems, from our other

>>>>>> ambulatory sites (I

>>>>>> am hospital employed), and, although these pts. are new to me, I

>>>>>> have

>>>>>> to

>>>>>> bill them as established because all of the sites have the same

>>>>>> Tax

>>>>>> Id,

>>>>>> and these pts are all considered established. Needing to cover so

>>>>>> many issues at the " new " visit obviously results in many (mostly)

>>>>>> 99214's. Realistically, I feel that my panel is not large enough

>>>>>> to

>>>>>> have even developed enough data for a " normal " bell curve, but I

>>>>>> could be just rationalizing all of this to support my data!

>>>>>>

>>>>>> My question-should I be pro active and contact the medical

>>>>>> director

>>>>>> of this HMO who sent the letter to discuss this, find out the time

>>>>>> frame for their previous monitoring, and do my own audit of my

>>>>>> charting? And if my charting supports my billing pursue this to

>>>>>> " prove " to them I am coding appropriately (if my charts verify

>>>>>> this)?

>>>>>> Or should I not worry about it, just be sure to focus particularly

>>>>>> on

>>>>>> this group to make sure

>>>>>> I do things appropriately in the future. I hate to just let this

>>>>>> go

>>>>>> because I feel they are sending out letters like this just to

>>>>>> scare

>>>>>> us into downcoding. My best friend is the compliance officer for a

>>>>>> nearby hospital ambulatory care center, doing all of their

>>>>>> auditing, and she also works for a company that does just such

>>>>>> audits

>>>>>> nationwide. She has

>>>>>> audited my charting previously, at my request, and tells me I am

>>>>>> doing things appropriately. But I hate to " tick off " this company

>>>>>> and

>>>>>> their director and forever have the spotlight on my practice. By

>>>>>> the way, I do

>>>>>> not have EHR; we use only paper charts with hand written notes. I

>>>>>> have used the StatCoder program on my PDA and find that, according

>>>>>> to

>>>>>> that, my coding is appropriate, although some issues like medical

>>>>>> decision making, can be somewhat grey areas.

>>>>>>

>>>>>> Any ideas would be appreciated.

>>>>>>

>>>>>> Sue

>>>>>>

>>>>>> _____

>>>>>>

>>>>>> YAHOO! GROUPS LINKS

>>>>>>

>>>>>> * Visit your group "

>>>>>> <http://groups.yahoo.com/group/> " on the web.

>>>>>>

>>>>>> *

February 13, 2006

Regarding the sterilization process, what is the reference for the requirements for cold vs "hot" sterilization?

Does it vary from state to state? thanks, RJE

--------- "Overcoding issues" > >>> > >>> I have been following this group and have learned a lot. I appreciate > >>> all of the advice! I have a question with which I would like some > >>> help. > >>> > >>> I recently received a letter from one of our larger HMO's that said > >>> my coding was above average for Family Medicine physicians, comparing > >>> their > >>> 2004 data to my 2005-as it related to 99214-15's. They said that they > >>> are going to monitor my billing and, if that trend continues, they > >>> will > >>> be auditing my records. > >>> > >>> My initial thoughts-I know that many of us previously downcoded to > >>> 13's > >>> so as not to have to think or document, or to avoid just such > >>> letters. I > >>> also know that the "bell curve" is moving upward because we are now > >>> becoming more proficient in coding, so the published data from even a > >>> few years ago is not accurate now. I am just starting up (1.5 years > >>> in this practice). I only have about 75 patients in my panel for this > >>> particular group, and, in this short time frame, it has been mainly > >>> the > >>> more "sick" patients that are coming in. I am getting many > >>> chronically ill patients with numerous problems, from our other > >>> ambulatory sites (I > >>> am hospital employed), and, although these pts. are new to me, I have > >>> to > >>> bill them as established because all of the sites have the same Tax > >>> Id, > >>> and these pts are all considered established. Needing to cover so > >>> many issues at the "new" visit obviously results in many (mostly) > >>> 99214's. Realistically, I feel that my panel is not large enough to > >>> have even developed enough data for a "normal" bell curve, but I > >>> could be just rationalizing all of this to support my data! > >>> > >>> My question-should I be pro active and contact the medical director > >>> of this HMO who sent the letter to discuss this, find out the time > >>> frame for their previous monitoring, and do my own audit of my > >>> charting? And if my charting supports my billing pursue this to > >>> "prove" to them I am coding appropriately (if my charts verify this)? > >>> Or should I not worry about it, just be sure to focus particularly on > >>> this group to make sure > >>> I do things appropriately in the future. I hate to just let this go > >>> because I feel they are sending out letters like this just to scare > >>> us into downcoding. My best friend is the compliance officer for a > >>> nearby hospital ambulatory care center, doing all of their auditing, > >>> and she also works for a company that does just such audits > >>> nationwide. She has > >>> audited my charting previously, at my request, and tells me I am > >>> doing things appropriately. But I hate to "tick off" this company and > >>> their director and forever have the spotlight on my practice. By the > >>> way, I do > >>> not have EHR; we use only paper charts with hand written notes. I > >>> have used the StatCoder program on my PDA and find that, according to > >>> that, my coding is appropriate, although some issues like medical > >>> decision making, can be somewhat grey areas. > >>> > >>> Any ideas would be appreciated. > >>> > >>> Sue > >>> > >>> > >>> > >>> _____ > >>> > >>> YAHOO! GROUPS LINKS > >>> > >>> * Visit your group " > >>> " on the web. > >>> > >>> *

February 13, 2006

Regarding the sterilization process, what is the reference for the requirements for cold vs "hot" sterilization?

Does it vary from state to state? thanks, RJE

--------- "Overcoding issues" > >>> > >>> I have been following this group and have learned a lot. I appreciate > >>> all of the advice! I have a question with which I would like some > >>> help. > >>> > >>> I recently received a letter from one of our larger HMO's that said > >>> my coding was above average for Family Medicine physicians, comparing > >>> their > >>> 2004 data to my 2005-as it related to 99214-15's. They said that they > >>> are going to monitor my billing and, if that trend continues, they > >>> will > >>> be auditing my records. > >>> > >>> My initial thoughts-I know that many of us previously downcoded to > >>> 13's > >>> so as not to have to think or document, or to avoid just such > >>> letters. I > >>> also know that the "bell curve" is moving upward because we are now > >>> becoming more proficient in coding, so the published data from even a > >>> few years ago is not accurate now. I am just starting up (1.5 years > >>> in this practice). I only have about 75 patients in my panel for this > >>> particular group, and, in this short time frame, it has been mainly > >>> the > >>> more "sick" patients that are coming in. I am getting many > >>> chronically ill patients with numerous problems, from our other > >>> ambulatory sites (I > >>> am hospital employed), and, although these pts. are new to me, I have > >>> to > >>> bill them as established because all of the sites have the same Tax > >>> Id, > >>> and these pts are all considered established. Needing to cover so > >>> many issues at the "new" visit obviously results in many (mostly) > >>> 99214's. Realistically, I feel that my panel is not large enough to > >>> have even developed enough data for a "normal" bell curve, but I > >>> could be just rationalizing all of this to support my data! > >>> > >>> My question-should I be pro active and contact the medical director > >>> of this HMO who sent the letter to discuss this, find out the time > >>> frame for their previous monitoring, and do my own audit of my > >>> charting? And if my charting supports my billing pursue this to > >>> "prove" to them I am coding appropriately (if my charts verify this)? > >>> Or should I not worry about it, just be sure to focus particularly on > >>> this group to make sure > >>> I do things appropriately in the future. I hate to just let this go > >>> because I feel they are sending out letters like this just to scare > >>> us into downcoding. My best friend is the compliance officer for a > >>> nearby hospital ambulatory care center, doing all of their auditing, > >>> and she also works for a company that does just such audits > >>> nationwide. She has > >>> audited my charting previously, at my request, and tells me I am > >>> doing things appropriately. But I hate to "tick off" this company and > >>> their director and forever have the spotlight on my practice. By the > >>> way, I do > >>> not have EHR; we use only paper charts with hand written notes. I > >>> have used the StatCoder program on my PDA and find that, according to > >>> that, my coding is appropriate, although some issues like medical > >>> decision making, can be somewhat grey areas. > >>> > >>> Any ideas would be appreciated. > >>> > >>> Sue > >>> > >>> > >>> > >>> _____ > >>> > >>> YAHOO! GROUPS LINKS > >>> > >>> * Visit your group " > >>> " on the web. > >>> > >>> *

February 13, 2006

Regarding the sterilization process, what is the reference for the requirements for cold vs "hot" sterilization?

Does it vary from state to state? thanks, RJE

--------- "Overcoding issues" > >>> > >>> I have been following this group and have learned a lot. I appreciate > >>> all of the advice! I have a question with which I would like some > >>> help. > >>> > >>> I recently received a letter from one of our larger HMO's that said > >>> my coding was above average for Family Medicine physicians, comparing > >>> their > >>> 2004 data to my 2005-as it related to 99214-15's. They said that they > >>> are going to monitor my billing and, if that trend continues, they > >>> will > >>> be auditing my records. > >>> > >>> My initial thoughts-I know that many of us previously downcoded to > >>> 13's > >>> so as not to have to think or document, or to avoid just such > >>> letters. I > >>> also know that the "bell curve" is moving upward because we are now > >>> becoming more proficient in coding, so the published data from even a > >>> few years ago is not accurate now. I am just starting up (1.5 years > >>> in this practice). I only have about 75 patients in my panel for this > >>> particular group, and, in this short time frame, it has been mainly > >>> the > >>> more "sick" patients that are coming in. I am getting many > >>> chronically ill patients with numerous problems, from our other > >>> ambulatory sites (I > >>> am hospital employed), and, although these pts. are new to me, I have > >>> to > >>> bill them as established because all of the sites have the same Tax > >>> Id, > >>> and these pts are all considered established. Needing to cover so > >>> many issues at the "new" visit obviously results in many (mostly) > >>> 99214's. Realistically, I feel that my panel is not large enough to > >>> have even developed enough data for a "normal" bell curve, but I > >>> could be just rationalizing all of this to support my data! > >>> > >>> My question-should I be pro active and contact the medical director > >>> of this HMO who sent the letter to discuss this, find out the time > >>> frame for their previous monitoring, and do my own audit of my > >>> charting? And if my charting supports my billing pursue this to > >>> "prove" to them I am coding appropriately (if my charts verify this)? > >>> Or should I not worry about it, just be sure to focus particularly on > >>> this group to make sure > >>> I do things appropriately in the future. I hate to just let this go > >>> because I feel they are sending out letters like this just to scare > >>> us into downcoding. My best friend is the compliance officer for a > >>> nearby hospital ambulatory care center, doing all of their auditing, > >>> and she also works for a company that does just such audits > >>> nationwide. She has > >>> audited my charting previously, at my request, and tells me I am > >>> doing things appropriately. But I hate to "tick off" this company and > >>> their director and forever have the spotlight on my practice. By the > >>> way, I do > >>> not have EHR; we use only paper charts with hand written notes. I > >>> have used the StatCoder program on my PDA and find that, according to > >>> that, my coding is appropriate, although some issues like medical > >>> decision making, can be somewhat grey areas. > >>> > >>> Any ideas would be appreciated. > >>> > >>> Sue > >>> > >>> > >>> > >>> _____ > >>> > >>> YAHOO! GROUPS LINKS > >>> > >>> * Visit your group " > >>> " on the web. > >>> > >>> *

February 13, 2006

I actually had problems finding definite, clearly-stated " requirements " .

I don't have the sites saved but I did find a few at CDC and some

professional organizations with " standards " explained. But standards and

requirements are not the same. My limited understanding of what I read

was that high disinfection may be suitable for simple skin procedures such

as what I will do while true sterilization would be needed for anything

entering a body cavity or if anything is to be left in the vasculature.

As I thought of it I considered the difference of simple procedures we'd

do without even a mask vs a formal, sterile surgical suite.

If someone has a clear statement about the details for disinfection /

autoclave I'd be interested to know. For me however, after spending a

good chunk of time getting basically no where in my decision making, I

called my friendly dentist and he's more than happy to let me use his

autoclave.

So, at least at this point, I'm planning to have a good many disposables

(blades, punch biopsies, etc) and a nice handful of basic instruments

which I'll keep clean and autoclave in batches every so often. It seems

like the best balance for me.

Tim

> Regarding the sterilization process, what is the reference for the

> requirements for cold vs " hot " sterilization? Does it vary from state

> to state? thanks, RJE

>

> --------- " Overcoding issues "

>> >>>

>> >>> I have been following this group and have learned a lot. I

>> appreciate all of the advice! I have a question with which I

>> would like some help.

>> >>>

>> >>> I recently received a letter from one of our larger HMO's that

>> said my coding was above average for Family Medicine physicians,

>> comparing their

>> >>> 2004 data to my 2005-as it related to 99214-15's. They said that

>> they are going to monitor my billing and, if that trend

>> continues, they will

>> >>> be auditing my records.

>> >>>

>> >>> My initial thoughts-I know that many of us previously downcoded to

>> 13's

>> >>> so as not to have to think or document, or to avoid just such

>> letters. I

>> >>> also know that the " bell curve " is moving upward because we are

>> now becoming more proficient in coding, so the published data

>> from even a few years ago is not accurate now. I am just starting

>> up (1.5 years in this practice). I only have about 75 patients in

>> my panel for this particular group, and, in this short time

>> frame, it has been mainly the

>> >>> more " sick " patients that are coming in. I am getting many

>> >>> chronically ill patients with numerous problems, from our other

>> ambulatory sites (I

>> >>> am hospital employed), and, although these pts. are new to me, I

>> have to

>> >>> bill them as established because all of the sites have the same

>> Tax Id,

>> >>> and these pts are all considered established. Needing to cover so

>> many issues at the " new " visit obviously results in many (mostly)

>> 99214's. Realistically, I feel that my panel is not large enough

>> to have even developed enough data for a " normal " bell curve, but

>> I could be just rationalizing all of this to support my data!

>> >>>

>> >>> My question-should I be pro active and contact the medical

>> director of this HMO who sent the letter to discuss this, find

>> out the time frame for their previous monitoring, and do my own

>> audit of my charting? And if my charting supports my billing

>> pursue this to " prove " to them I am coding appropriately (if my

>> charts verify this)? Or should I not worry about it, just be sure

>> to focus particularly on this group to make sure

>> >>> I do things appropriately in the future. I hate to just let this

>> go because I feel they are sending out letters like this just to

>> scare us into downcoding. My best friend is the compliance

>> officer for a nearby hospital ambulatory care center, doing all

>> of their auditing, and she also works for a company that does

>> just such audits nationwide. She has

>> >>> audited my charting previously, at my request, and tells me I am

>> doing things appropriately. But I hate to " tick off " this company

>> and their director and forever have the spotlight on my practice.

>> By the way, I do

>> >>> not have EHR; we use only paper charts with hand written notes. I

>> have used the StatCoder program on my PDA and find that, according

>> to that, my coding is appropriate, although some issues like

>> medical decision making, can be somewhat grey areas.

>> >>>

>> >>> Any ideas would be appreciated.

>> >>>

>> >>> Sue

>> >>>

>> >>> _____

>> >>>

>> >>> YAHOO! GROUPS LINKS

>> >>>

>> >>> * Visit your group "

>> >>> " on the web.

>> >>>

>> >>> *

February 13, 2006