Re: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

[Guest guest]

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212 15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled "Improving you Coding Skills" from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve. MachataSubject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21

AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance: 99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.Helen

[Guest guest]

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212 15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled "Improving you Coding Skills" from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve. MachataSubject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21

AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance: 99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.Helen

[Guest guest]

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212 15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled "Improving you Coding Skills" from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve. MachataSubject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21

AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance: 99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.Helen

[Guest guest]

ACP has a tool to examine practice charges and graphs your input against national averages. If you are interested I can find the product for you.

To: Sent: Tue, March 8, 2011 5:31:16 AMSubject: Re: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212 15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled "Improving you Coding Skills" from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve. Machata

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance: 99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.Helen

[Guest guest]

ACP has a tool to examine practice charges and graphs your input against national averages. If you are interested I can find the product for you.

To: Sent: Tue, March 8, 2011 5:31:16 AMSubject: Re: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212 15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled "Improving you Coding Skills" from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve. Machata

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance: 99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.Helen

[Guest guest]

who says you have to meet national average?? DocumentShow them your workI think one iMP i took her HYH numbers + mine that were similar + my medicaid cost quality data and  said to BLue Cross hey what's a few extra 99214's when we  save you 50,000 a year on even a small panel of patietns

You  document that work, then  you creat your own averge What nonsense. You have a contract that  says you have to be avergae?As the country gets older and our jobs are more and more complex     we are not going to be  doing 99213s and 99212s

 Create a new norm .document and show your  work.They are knuckleheads.( Extraordinarily difficult episode with Earl Carstensen a fp  in CO few yrs ago  40% of his practice was UNited United threatend him severely over this stuff  For ahwile he  just made everyone come back over and over to get 99213s but I think he finally  succeeded in geting them off his back- anyone know Earl and the outcome? Was on AAFP list serv.SOme precedent  there )

Good luck.

 

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

 

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the " national average " .I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

--      MD          ph    fax

[Guest guest]

who says you have to meet national average?? DocumentShow them your workI think one iMP i took her HYH numbers + mine that were similar + my medicaid cost quality data and  said to BLue Cross hey what's a few extra 99214's when we  save you 50,000 a year on even a small panel of patietns

You  document that work, then  you creat your own averge What nonsense. You have a contract that  says you have to be avergae?As the country gets older and our jobs are more and more complex     we are not going to be  doing 99213s and 99212s

 Create a new norm .document and show your  work.They are knuckleheads.( Extraordinarily difficult episode with Earl Carstensen a fp  in CO few yrs ago  40% of his practice was UNited United threatend him severely over this stuff  For ahwile he  just made everyone come back over and over to get 99213s but I think he finally  succeeded in geting them off his back- anyone know Earl and the outcome? Was on AAFP list serv.SOme precedent  there )

Good luck.

 

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

 

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the " national average " .I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

--      MD          ph    fax

[Guest guest]

who says you have to meet national average?? DocumentShow them your workI think one iMP i took her HYH numbers + mine that were similar + my medicaid cost quality data and  said to BLue Cross hey what's a few extra 99214's when we  save you 50,000 a year on even a small panel of patietns

You  document that work, then  you creat your own averge What nonsense. You have a contract that  says you have to be avergae?As the country gets older and our jobs are more and more complex     we are not going to be  doing 99213s and 99212s

 Create a new norm .document and show your  work.They are knuckleheads.( Extraordinarily difficult episode with Earl Carstensen a fp  in CO few yrs ago  40% of his practice was UNited United threatend him severely over this stuff  For ahwile he  just made everyone come back over and over to get 99213s but I think he finally  succeeded in geting them off his back- anyone know Earl and the outcome? Was on AAFP list serv.SOme precedent  there )

Good luck.

 

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

 

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the " national average " .I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

--      MD          ph    fax

[Guest guest]

Excellent points, Jean.IMP docs are striving, as Garrison Keilor of Lake Woebegone fame says, "to all be above average". As emphasizes, documentation must support excellence.Excellent medicine is likely to slightly increase primary care costs while overall saving money and increasing patient satisfaction.Even if opting for a 99214 based on > 1/2 time counseling and >= 25 minutes it is critical to document nature of counseling in cogent fashion.As someone trapped currently in an every ten minute (99213!) rat race geared to generate maximum revenue thoughtful care is routinely sacrificed.Wasn't it Zippy who asked, "Why be normal?!"

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

-- MD ph fax

[Guest guest]

Excellent points, Jean.IMP docs are striving, as Garrison Keilor of Lake Woebegone fame says, "to all be above average". As emphasizes, documentation must support excellence.Excellent medicine is likely to slightly increase primary care costs while overall saving money and increasing patient satisfaction.Even if opting for a 99214 based on > 1/2 time counseling and >= 25 minutes it is critical to document nature of counseling in cogent fashion.As someone trapped currently in an every ten minute (99213!) rat race geared to generate maximum revenue thoughtful care is routinely sacrificed.Wasn't it Zippy who asked, "Why be normal?!"

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

-- MD ph fax

[Guest guest]

Excellent points, Jean.IMP docs are striving, as Garrison Keilor of Lake Woebegone fame says, "to all be above average". As emphasizes, documentation must support excellence.Excellent medicine is likely to slightly increase primary care costs while overall saving money and increasing patient satisfaction.Even if opting for a 99214 based on > 1/2 time counseling and >= 25 minutes it is critical to document nature of counseling in cogent fashion.As someone trapped currently in an every ten minute (99213!) rat race geared to generate maximum revenue thoughtful care is routinely sacrificed.Wasn't it Zippy who asked, "Why be normal?!"

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

-- MD ph fax

[Guest guest]

You are right on, Jean. I

rarely code a 99213 anymore – by far most of mine are 99214s, 99215s, and

frequently with 99354s added on for additional time. I document all of it for

time, and am definitely an outlier. But I guess I can be more cavalier as I am

not contracted with any insurance companies.

We IMPs are not the norm, thank

God!

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Jean

Antonucci

Sent: Tuesday, March 08, 2011 6:09 AM

To:

Subject: Re: Anyone knows the stats on CPT coding

pattern or % for 99213, 99214, 99215 for PCP MDs?

who says you have to meet national average??

Document

Show them your work

I think one iMP i took her HYH numbers + mine that were similar + my medicaid

cost quality data and said to BLue Cross hey what's a few extra 99214's

when we save you 50,000 a year on even a small panel of patietns

You document that work, then you creat your own averge What

nonsense. You have a contract that says you have to be avergae?

As the country gets older and our jobs are more and more

complex we are not going to be doing 99213s and

99212s

Create a new norm .document and show your work.

They are knuckleheads.

( Extraordinarily difficult episode with Earl Carstensen a fp in CO few

yrs ago 40% of his practice was UNited United threatend him severely over

this stuff For ahwile he just made everyone come back over and over

to get 99213s but I think he finally succeeded in geting them off his

back- anyone know Earl and the outcome? Was on AAFP list serv.SOme

precedent there )

Good luck.

Subject: Anyone knows the stats on CPT coding pattern

or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >

Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.

I have been told by one commercial insurance carrier that my coding pattern

did not match the " national average " .

I have a lot sick and complexed pts with over 90% IM practice and less than

10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%

99214: 51%

99215: 32%

99354: 12%

Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for

PCP MDs? Please share the stats information or the link to the info. Thank

you very much for your kind help.

Helen

--

MD

ph fax

[Guest guest]

You are right on, Jean. I

rarely code a 99213 anymore – by far most of mine are 99214s, 99215s, and

frequently with 99354s added on for additional time. I document all of it for

time, and am definitely an outlier. But I guess I can be more cavalier as I am

not contracted with any insurance companies.

We IMPs are not the norm, thank

God!

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Jean

Antonucci

Sent: Tuesday, March 08, 2011 6:09 AM

To:

Subject: Re: Anyone knows the stats on CPT coding

pattern or % for 99213, 99214, 99215 for PCP MDs?

who says you have to meet national average??

Document

Show them your work

I think one iMP i took her HYH numbers + mine that were similar + my medicaid

cost quality data and said to BLue Cross hey what's a few extra 99214's

when we save you 50,000 a year on even a small panel of patietns

You document that work, then you creat your own averge What

nonsense. You have a contract that says you have to be avergae?

As the country gets older and our jobs are more and more

complex we are not going to be doing 99213s and

99212s

Create a new norm .document and show your work.

They are knuckleheads.

( Extraordinarily difficult episode with Earl Carstensen a fp in CO few

yrs ago 40% of his practice was UNited United threatend him severely over

this stuff For ahwile he just made everyone come back over and over

to get 99213s but I think he finally succeeded in geting them off his

back- anyone know Earl and the outcome? Was on AAFP list serv.SOme

precedent there )

Good luck.

Subject: Anyone knows the stats on CPT coding pattern

or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >

Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.

I have been told by one commercial insurance carrier that my coding pattern

did not match the " national average " .

I have a lot sick and complexed pts with over 90% IM practice and less than

10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%

99214: 51%

99215: 32%

99354: 12%

Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for

PCP MDs? Please share the stats information or the link to the info. Thank

you very much for your kind help.

Helen

--

MD

ph fax

[Guest guest]

You are right on, Jean. I

rarely code a 99213 anymore – by far most of mine are 99214s, 99215s, and

frequently with 99354s added on for additional time. I document all of it for

time, and am definitely an outlier. But I guess I can be more cavalier as I am

not contracted with any insurance companies.

We IMPs are not the norm, thank

God!

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Jean

Antonucci

Sent: Tuesday, March 08, 2011 6:09 AM

To:

Subject: Re: Anyone knows the stats on CPT coding

pattern or % for 99213, 99214, 99215 for PCP MDs?

who says you have to meet national average??

Document

Show them your work

I think one iMP i took her HYH numbers + mine that were similar + my medicaid

cost quality data and said to BLue Cross hey what's a few extra 99214's

when we save you 50,000 a year on even a small panel of patietns

You document that work, then you creat your own averge What

nonsense. You have a contract that says you have to be avergae?

As the country gets older and our jobs are more and more

complex we are not going to be doing 99213s and

99212s

Create a new norm .document and show your work.

They are knuckleheads.

( Extraordinarily difficult episode with Earl Carstensen a fp in CO few

yrs ago 40% of his practice was UNited United threatend him severely over

this stuff For ahwile he just made everyone come back over and over

to get 99213s but I think he finally succeeded in geting them off his

back- anyone know Earl and the outcome? Was on AAFP list serv.SOme

precedent there )

Good luck.

Subject: Anyone knows the stats on CPT coding pattern

or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >

Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.

I have been told by one commercial insurance carrier that my coding pattern

did not match the " national average " .

I have a lot sick and complexed pts with over 90% IM practice and less than

10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%

99214: 51%

99215: 32%

99354: 12%

Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for

PCP MDs? Please share the stats information or the link to the info. Thank

you very much for your kind help.

Helen

--

MD

ph fax

[Guest guest]

(Apologies if this change has already come up - isn't letting me search message texts.)

 

Just a note on time-based coding, from CPT Professional Edition 2011:

 

" When counseling and/or coordination of care dominates (more than 50%) of the physician/patient and/or family encounter, then time SHALL be considered the key or controlling factor to qualify for a particular level of E/M services. The extent of counseling and/or coordination of care must be documented in the medical record.' "

 

Note that the " SHALL be considered " is a departure from the historic " MAY be considered. "

 

They might quibble about what you did in 2010, but from here on out, if you chart time-based counseling, you are in the right.

 

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

 

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212  15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled " Improving you Coding Skills " from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve.

Machata

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

 

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the " national average " .I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

[Guest guest]

(Apologies if this change has already come up - isn't letting me search message texts.)

 

Just a note on time-based coding, from CPT Professional Edition 2011:

 

" When counseling and/or coordination of care dominates (more than 50%) of the physician/patient and/or family encounter, then time SHALL be considered the key or controlling factor to qualify for a particular level of E/M services. The extent of counseling and/or coordination of care must be documented in the medical record.' "

 

Note that the " SHALL be considered " is a departure from the historic " MAY be considered. "

 

They might quibble about what you did in 2010, but from here on out, if you chart time-based counseling, you are in the right.

 

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

 

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212  15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled " Improving you Coding Skills " from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve.

Machata

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

 

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the " national average " .I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

[Guest guest]

I think Helen's question is more in terms " what can I do to STOP the second guessing? " This change should help

 

(Apologies if this change has already come up - isn't letting me search message texts.)

 

Just a note on time-based coding, from CPT Professional Edition 2011:

 

" When counseling and/or coordination of care dominates (more than 50%) of the physician/patient and/or family encounter, then time SHALL be considered the key or controlling factor to qualify for a particular level of E/M services. The extent of counseling and/or coordination of care must be documented in the medical record.' "

 

Note that the " SHALL be considered " is a departure from the historic " MAY be considered. "

 

They might quibble about what you did in 2010, but from here on out, if you chart time-based counseling, you are in the right.

 

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

 

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212  15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled " Improving you Coding Skills " from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve.

Machata

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

 

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the " national average " .I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

-- Sangeetha

[Guest guest]

I think Helen's question is more in terms " what can I do to STOP the second guessing? " This change should help

 

(Apologies if this change has already come up - isn't letting me search message texts.)

 

Just a note on time-based coding, from CPT Professional Edition 2011:

 

" When counseling and/or coordination of care dominates (more than 50%) of the physician/patient and/or family encounter, then time SHALL be considered the key or controlling factor to qualify for a particular level of E/M services. The extent of counseling and/or coordination of care must be documented in the medical record.' "

 

Note that the " SHALL be considered " is a departure from the historic " MAY be considered. "

 

They might quibble about what you did in 2010, but from here on out, if you chart time-based counseling, you are in the right.

 

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

 

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212  15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled " Improving you Coding Skills " from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve.

Machata

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

 

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the " national average " .I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

-- Sangeetha

[Guest guest]

I think Helen's question is more in terms " what can I do to STOP the second guessing? " This change should help

 

(Apologies if this change has already come up - isn't letting me search message texts.)

 

Just a note on time-based coding, from CPT Professional Edition 2011:

 

" When counseling and/or coordination of care dominates (more than 50%) of the physician/patient and/or family encounter, then time SHALL be considered the key or controlling factor to qualify for a particular level of E/M services. The extent of counseling and/or coordination of care must be documented in the medical record.' "

 

Note that the " SHALL be considered " is a departure from the historic " MAY be considered. "

 

They might quibble about what you did in 2010, but from here on out, if you chart time-based counseling, you are in the right.

 

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

 

Helen- My data is a few years old and I am depending on my memory but the national averages are something like this:99212  15-25 %99213: 45-55%99214: 15-25%99215: 5-15%There is a helpful video entitled " Improving you Coding Skills " from UC on CMECalifornia. As an outlier you need to accurately document the basis for being off the bell curve.

Machata

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: " IMP Group " <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

 

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the " national average " .I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

--

 

Be well,

 

Bill Walter ND

Golden Apple Healthcare, LLC

billwalter@...

www.goldenapplehealthcare.com

-- Sangeetha

[Guest guest]

When I was the QA head in the Navy I went to a conference where they told us that one of the biggest motivators for physicians was to be under the curve. They said a huge proportion of us would modify our behaviors just by getting notification that we were out of step with our peers I think we are all really ingrained in the mindset from years of education or something, that we need to avoid being outliers. I try to remember that when I hear I am out of step. Kris Oaks

Excellent points, Jean.IMP docs are striving, as Garrison Keilor of Lake Woebegone fame says, "to all be above average". As emphasizes, documentation must support excellence.Excellent medicine is likely to slightly increase primary care costs while overall saving money and increasing patient satisfaction.Even if opting for a 99214 based on > 1/2 time counseling and >= 25 minutes it is critical to document nature of counseling in cogent fashion.As someone trapped currently in an every ten minute (99213!) rat race geared to generate maximum revenue thoughtful care is routinely sacrificed.Wasn't it Zippy who asked, "Why be normal?!"

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

-- MD ph fax

[Guest guest]

When I was the QA head in the Navy I went to a conference where they told us that one of the biggest motivators for physicians was to be under the curve. They said a huge proportion of us would modify our behaviors just by getting notification that we were out of step with our peers I think we are all really ingrained in the mindset from years of education or something, that we need to avoid being outliers. I try to remember that when I hear I am out of step. Kris Oaks

Excellent points, Jean.IMP docs are striving, as Garrison Keilor of Lake Woebegone fame says, "to all be above average". As emphasizes, documentation must support excellence.Excellent medicine is likely to slightly increase primary care costs while overall saving money and increasing patient satisfaction.Even if opting for a 99214 based on > 1/2 time counseling and >= 25 minutes it is critical to document nature of counseling in cogent fashion.As someone trapped currently in an every ten minute (99213!) rat race geared to generate maximum revenue thoughtful care is routinely sacrificed.Wasn't it Zippy who asked, "Why be normal?!"

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance:

99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.

Helen

-- MD ph fax

[Guest guest]

But here is the problem with this and more importantly why those in charge of policing such policies love to use this method of "Behavior Modification". In the end the general population of doctors after repeatedly trying to stay "Under a Curve" like this, the eventual real outcome has to be that it actual changes the curve and data itself in a downward trend leading to more and more undercoding and undervaluing your own work. Which then starts the process all over again and so we are now almost certainly in some horrible repetitive pattern of the tail wagging the dog, every going downward as more and more docs get spanked and therefore once again adjust their behavior towards the negative side of the data to stay "Below" the radar.

Funny how they never come to docs to let them know they are a "Negative" outlier and could use to increase and start "Upcoding" their work and value.... Only those who are over the curve get any feedback, never the opposite side. Without such feedback for the other side of the curve, you only have pressure to move the curve in one direction and never a counter force against that one direction. So again this supports my theory of every advancing downwards coding and the boundary at which one gets the negative reinforcement Skinnerian like "Shock" applied.... continues to go downward as well. Furthermore there never is the positive reinforcement of rewarding those that are coding too tightly or under coding to increase their coding and that doing so is a part of what we reward and want. We want to properly pay and rewardsthose who do the work of caring for all of our citizen's healthcare needs.

Cat Herding, Negative Reinforcement, Skinnerian Conditioning... All of which, if experienced harshly and or enough times creates a well know and documented form of depression called "Learned Helplessness". I would say that a majority of primary care doctors who are hamsters caught on their wheels and can't seem to find a way off, probably start to develop some form of Learned Helplessness. What a nice way to treat those who care for everybody else in our society.... How many here are still recovering and how many here still need to start that difficult process of disconnecting from the Matrix....

What was that we discussed awhile back about the Red Pill and the Blue Pill Nemo??? Aaaahhh Dr. .....

To: Sent: Tue, March 8, 2011 5:56:45 PMSubject: Re: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

When I was the QA head in the Navy I went to a conference where they told us that one of the biggest motivators for physicians was to be under the curve. They said a huge proportion of us would modify our behaviors just by getting notification that we were out of step with our peers I think we are all really ingrained in the mindset from years of education or something, that we need to avoid being outliers. I try to remember that when I hear I am out of step. Kris Oaks

Excellent points, Jean. IMP docs are striving, as Garrison Keilor of Lake Woebegone fame says, "to all be above average".

As emphasizes, documentation must support excellence.

Excellent medicine is likely to slightly increase primary care costs while overall saving money and increasing patient satisfaction.

Even if opting for a 99214 based on > 1/2 time counseling and >= 25 minutes it is critical to document nature of counseling in cogent fashion.

As someone trapped currently in an every ten minute (99213!) rat race geared to generate maximum revenue thoughtful care is routinely sacrificed.

Wasn't it Zippy who asked, "Why be normal?!"

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance: 99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.Helen

-- MD ph fax

[Guest guest]

But here is the problem with this and more importantly why those in charge of policing such policies love to use this method of "Behavior Modification". In the end the general population of doctors after repeatedly trying to stay "Under a Curve" like this, the eventual real outcome has to be that it actual changes the curve and data itself in a downward trend leading to more and more undercoding and undervaluing your own work. Which then starts the process all over again and so we are now almost certainly in some horrible repetitive pattern of the tail wagging the dog, every going downward as more and more docs get spanked and therefore once again adjust their behavior towards the negative side of the data to stay "Below" the radar.

Funny how they never come to docs to let them know they are a "Negative" outlier and could use to increase and start "Upcoding" their work and value.... Only those who are over the curve get any feedback, never the opposite side. Without such feedback for the other side of the curve, you only have pressure to move the curve in one direction and never a counter force against that one direction. So again this supports my theory of every advancing downwards coding and the boundary at which one gets the negative reinforcement Skinnerian like "Shock" applied.... continues to go downward as well. Furthermore there never is the positive reinforcement of rewarding those that are coding too tightly or under coding to increase their coding and that doing so is a part of what we reward and want. We want to properly pay and rewardsthose who do the work of caring for all of our citizen's healthcare needs.

Cat Herding, Negative Reinforcement, Skinnerian Conditioning... All of which, if experienced harshly and or enough times creates a well know and documented form of depression called "Learned Helplessness". I would say that a majority of primary care doctors who are hamsters caught on their wheels and can't seem to find a way off, probably start to develop some form of Learned Helplessness. What a nice way to treat those who care for everybody else in our society.... How many here are still recovering and how many here still need to start that difficult process of disconnecting from the Matrix....

What was that we discussed awhile back about the Red Pill and the Blue Pill Nemo??? Aaaahhh Dr. .....

To: Sent: Tue, March 8, 2011 5:56:45 PMSubject: Re: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?

When I was the QA head in the Navy I went to a conference where they told us that one of the biggest motivators for physicians was to be under the curve. They said a huge proportion of us would modify our behaviors just by getting notification that we were out of step with our peers I think we are all really ingrained in the mindset from years of education or something, that we need to avoid being outliers. I try to remember that when I hear I am out of step. Kris Oaks

Excellent points, Jean. IMP docs are striving, as Garrison Keilor of Lake Woebegone fame says, "to all be above average".

As emphasizes, documentation must support excellence.

Excellent medicine is likely to slightly increase primary care costs while overall saving money and increasing patient satisfaction.

Even if opting for a 99214 based on > 1/2 time counseling and >= 25 minutes it is critical to document nature of counseling in cogent fashion.

As someone trapped currently in an every ten minute (99213!) rat race geared to generate maximum revenue thoughtful care is routinely sacrificed.

Wasn't it Zippy who asked, "Why be normal?!"

Subject: Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs?To: "IMP Group" <practiceimprovement1 >Date: Tuesday, March 8, 2011, 12:21 AM

Please help me.I have been told by one commercial insurance carrier that my coding pattern did not match the "national average".I have a lot sick and complexed pts with over 90% IM practice and less than 10% peds. My numbers from the past 253 visits under this insurance: 99213: 17%99214: 51%99215: 32%99354: 12%Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for PCP MDs? Please share the stats information or the link to the info. Thank you very much for your kind help.Helen

-- MD ph fax

[Guest guest]

Turns out that every practice thinks that they have the sickest and most complex

patients, but that this does not hold up. However, the average PCP undercodes,

so by trying to get to to be " avearge " is trying to get you to undercode.

An article in AAFP FPM from Dec 2009 show that optimal coding is

99211 2% (assuming you have staff)

99212 8%

99213: 25%

99214: 60%

99215: 5%

On the other hand if you bill much on time, as I do, for psych and things like

DM visit, I hit more along the:

99214 60%

99215 20

99213 10

If you spent 45 minutes doing DM counseling you should get paid for it.

________________________________________

From:

[ ] On Behalf Of Helen Yang

[helenwyang@...]

Sent: Monday, March 07, 2011 10:21 PM

To: IMP Group

Subject: Anyone knows the stats on CPT coding pattern or

% for 99213, 99214, 99215 for PCP MDs?

Please help me.

I have been told by one commercial insurance carrier that my coding pattern did

not match the " national average " .

I have a lot sick and complexed pts with over 90% IM practice and less than 10%

peds. My numbers from the past 253 visits under this insurance:

99213: 17%

99214: 51%

99215: 32%

99354: 12%

Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for

PCP MDs? Please share the stats information or the link to the info. Thank you

very much for your kind help.

Helen

[Guest guest]

Turns out that every practice thinks that they have the sickest and most complex

patients, but that this does not hold up. However, the average PCP undercodes,

so by trying to get to to be " avearge " is trying to get you to undercode.

An article in AAFP FPM from Dec 2009 show that optimal coding is

99211 2% (assuming you have staff)

99212 8%

99213: 25%

99214: 60%

99215: 5%

On the other hand if you bill much on time, as I do, for psych and things like

DM visit, I hit more along the:

99214 60%

99215 20

99213 10

If you spent 45 minutes doing DM counseling you should get paid for it.

________________________________________

From:

[ ] On Behalf Of Helen Yang

[helenwyang@...]

Sent: Monday, March 07, 2011 10:21 PM

To: IMP Group

Subject: Anyone knows the stats on CPT coding pattern or

% for 99213, 99214, 99215 for PCP MDs?

Please help me.

I have been told by one commercial insurance carrier that my coding pattern did

not match the " national average " .

I have a lot sick and complexed pts with over 90% IM practice and less than 10%

peds. My numbers from the past 253 visits under this insurance:

99213: 17%

99214: 51%

99215: 32%

99354: 12%

Anyone knows the stats on CPT coding pattern or % for 99213, 99214, 99215 for

PCP MDs? Please share the stats information or the link to the info. Thank you

very much for your kind help.

Helen