Coding

  • 1.  Office visit codes

    Posted 02-22-2024 10:28

    I have been a Practice Manager for some time but am new to the specialty.  What is the typical percentage for office visit codes for MFM docs

    99211

    99212

    99213

    99214

    99215



    ------------------------------
    Pam Keeney
    ------------------------------


  • 2.  RE: Office visit codes

    Posted 02-23-2024 14:28

    Hello,

    It depends on the practice specifics. In most cases, the distribution would follow a bell shape curve.

    Fadi



    ------------------------------
    Fadi Bsat, MD, FAIUM
    Past Chair, SMFM Practice Management Committee
    Past Chair, SMFM Coding Committee
    ------------------------------



  • 3.  RE: Office visit codes

    Posted 02-23-2024 17:51

    A past history question of this answer would follow very closely to what Fadi's as below.  You can look that up at this link.  This is for free on the S MFM website- https://s3.amazonaws.com/cdn.smfm.org/media/1389/Slides.pdf

    This question is also very different based upon the type of coding method that you utilize.  If you utilize a time-based method, which I do not recommend, it will appear more like Fadi's response below.  I think most people now are moving towards medical decision making type of consultation which does not require physical exam except for variables of importance to the assessment and plan.  If you do that, most of the patients that we take care of as consultants have moderate or high decision making complexity and hence would end up being over 04/14 for or 05/15 codes.  Hence I think the pattern should be more skewed towards the higher level exam codes.  I would generally believe that maybe 75 to 90% of the coding should be billed in this region in my opinion.



    ------------------------------
    Brian Iriye
    ------------------------------



  • 4.  RE: Office visit codes

    Posted 02-24-2024 09:41
      |   view attached

    Remember that 2 of 3 key components must be met to bill at that complexity level, not just MDM. Dr. Iriye believes that billing is skewed towards higher levels when using MDM. Though this may or may not be the case for initial visits or consultations, I do not believe this is the case for established patients (99211-99215). I could not find the CPT codes in question in the link he provided. For established patients, I would still believe billing would follow a bell shape curve for complexity, whether based on time or MDM. Unfortunately, reliable contemporary data is unavailable for MFMs. The SMFM Practice Management Committee is planning a benchmark survey that hopefully will help answer this. Also, keep in mind that what may be high MDM for a generalist, could be low or moderate complexity for an MFM. At the end, it depends on your mix of patients and how they present at these established visits. Irrespective of your billing distribution, I recommend performing routine audits of your practice's billing to confirm appropriate billing compliance and avoid unpleasant surprises with a payer audit, which may be triggered when one is billing predominately at higher levels.



    ------------------------------
    Fadi Bsat, MD, FAIUM
    Past Chair, SMFM Practice Management Committee
    Past Chair, SMFM Coding Committee
    ------------------------------



  • 5.  RE: Office visit codes

    Posted 02-24-2024 21:13

    The coding via MDM and SMFM guidelines are also listed online here:  https://s3.amazonaws.com/cdn.smfm.org/media/3888/2023_EM_Office-Outpatient_Coding_Grid_SMFM_-_V2.pdf

    I believe that there should be a skewing towards more higher level codes and if documentation is adequate i believe it would be supported.  Within our MFM practice I was able to look at our past coding as I run audits ever 3-4 months.  Within our data, 97% of coding for return follow ups is 99213-99215 with a majority at 99214.   As an aside, our coding has also been validated for accuracy by a coder who works as a consultant for SMFM and ACOG.   This of course has taken training for appropriate documentation of our staff.



    ------------------------------
    Brian Iriye
    ------------------------------



  • 6.  RE: Office visit codes

    Posted 02-24-2024 22:55

    Dr. Iriye,

    99211 being a nurse visit code, the distribution is therefore for 99212-99215, which would peak at 99213 or 99214. I would think that scenario is also possible if advanced practitioners in a practice are seeing established patients with lower complexity (99212-99213), leaving the mid and higher complexity patients to MFM physicians (99213-99215). As mentioned earlier, I recommmend all practices to do what you have done in yours, with routine internal audits, expert outside consultation and provider documentation education. I often tell folks to bill and document correctly and not worry much about the distribution of their CPT codes.

    Best,

    Fadi



    ------------------------------
    Fadi Bsat, MD, FAIUM
    Past Chair, SMFM Practice Management Committee
    Past Chair, SMFM Coding Committee
    ------------------------------