From Mad to Glad: Talking with Clinicians about Coding

Betsy Nicoletti, M.S., CPC July 11th, 2011

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Learn how to talk with clinicians to improve the medical coding process

Too many coding meetings with physicians end badly: the physician is frustrated and annoyed, the coder worried and angry. The result is that too little information is exchanged. It’s understandable; physicians want to practice medicine and are not always interested in the intricacies of Medicare and payer rules. The coder wants to protect the practice and submit a claim that complies with coding and reimbursement policies. How can these meetings be productive and positive? Here are my best strategies to go from mad to glad when talking about coding:

    Let the physician talk first: Always listen to the doctor first. “Dr. Abbott, thank you for making time to meet with me. Before I start on my agenda, which includes review of the global surgical package, E/M services and use of modifier 25, are there any coding issues you’d like to discuss first? I want to make sure your questions are answered in the hour we have together.” Many clinicians have a burning issue to discuss right off the bat. This approach tells them that their agenda is paramount. Sometimes, the clinician wants to vent their frustration at the reimbursement system. Don’t respond defensively or personally, and acknowledge the frustration. If the physician has no questions or issues, another good start question is “Can you tell me about your practice, and the kind of patients you treat?” Not all practices are alike, even within the same specialty group. It’s important not to lose control of the meeting, but answering the physician’s questions first will make the physician more receptive to the organization’s agenda for the meeting.
    Bring specialty-specific information and examples: Each physician specialty has a different list of most frequently billed CPT and ICD-9 codes. Most physician specialties bill for Evaluation and Management codes, but the procedures and other services performed vary widely. Bring that specialty information to the meeting. “One agenda fits all” doesn’t work. The physician’s own specialty society is the best source of accurate, specific coding information. Using the specialty society as a resource is the most credible for the physician. Nothing alienates a specialist more than primary care coding examples, and the reverse is equally true.
    Start with the good news: When discussing the audit results, start with the good news. Review the codes that were audited as correct and accurate, and move from there to examples of coding disagreement. If there are two services, one of which was coded as “Agree” and one coded at a different level than selected by the physician, show them next to each other, lead on a positive note. Sometimes, it is effective to start with the low level codes in the sample, and move up to the higher-level codes. Group the feedback into categories: reviewing all new patients, for example, and then reviewing the established patients. This allows the coder to concentrate their comments about a particular category of code or use of modifiers. If there are coding changes or new codes to review, starting with those is a good tactic.
    Avoid percentage error rates for the first audit: Physicians didn’t get to the top of their classes in biology, chemistry and math, didn’t get high scores on their Medical College Admission Tests (MCATs) in order to be told they are failures. “Doctor, you may be smart, but I’ve rated you at 30%.” I’d be mad too. Large organizations often establish a passing threshold or accuracy rate. While this is importance for compliance, concentrate on education for the first audit, and calculate error rates later.
    Use source citations: When the coder and the physician cannot agree on correct coding, here are a few statements to avoid making:
    “I don’t look good in orange.”
    “I went to a seminar, and the consultant said….”
    And, “I called my friend in another OB office, and she said…”
    Look for source documentation to answer coding questions. For strictly coding questions, the source is the CPT book, the CPT Assistant and the CPT Insiders View, Changes, published each year. For Medicare, look on the Medicare Administrative Contractor’s website or CMS’s website. Reimbursement policies by payer are often answered in their on line policy manuals. Specialty specific questions can often be answered by the physician’s specialty society. Many societies allow physician members 3-5 free coding questions per year. Carefully draft the question, and ask the physician to submit it to their society.
    Admit mistakes: Sometimes, in reviewing a note with the physician, I find that I was wrong about a note. When that happens, apologize briefly and without embarrassment, and amend the report.
    Don’t take criticism about the coding system personally: Although I avoid saying, “Hey, I didn’t make these rules,” or “Don’t shoot me, I’m only the messenger,” reasonable physicians know this. Some are very frustrated and unhappy with the state of medicine or their employment. If they express that forcefully in a meeting, I never take it personally. Then, there’s a good chance the meeting will recover, get on track and end in a productive exchange of information.

Betsy Nicoletti provides tips on how to talk to clinicians about medical codingBetsy Nicoletti, M.S., CPC, is the founder of Codapedia.com, a wiki for physician reimbursement. She is a nationally known speaker and consultant, and can be reached at www.mpconsulting.org. You can hear Betsy live in a complimentary webinar presented by Kareo on July 26 on “What You Can Do to Prepare for Medicare Payment Reductions.”

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