BETTER CODING: Make What You Earn<

by: Pamela Moore

Five Steps to Fixing Your Coding

Lots of practices miss revenue thanks to sloppy coding. And we’re not talking about losing pennies. Annette Grady, an auditor, says she routinely finds mistakes that add up to anywhere from $15,000 to $30,000 in lost revenue from a standard review of just 15 charts from a surgical practice. Grady is a healthcare advisor for Eide Bailly in Phoenix and an officer for the American Academy of Professional Coder’s (AAPC) National Advisory Board.

Luckily, a few tips can help you find what’s gone astray.

Physicians Practice interviewed people who make a living auditing charts and billing records to find missing money and asked what common mistakes they see. Here’s their list of top mistakes. Work on these — and start getting paid more.

It’s a Superbill, Not a Perfect Bill

Don’t rely on your superbill or charge ticket — the document with a list of codes on it you use to show the billing staff what you did. It’s probably incomplete or includes old codes and useless code descriptions.

“What I’ve run into recently is where the charge ticket or superbill did not have all of the codes, and had codes that weren’t appropriate, so the physicians weren’t marking services that they did,” says Lisa Souba with LAS Practice Management and Coding Services in Breckenridge, Colo. If it’s not on your list of options, it just never gets noted.

For example, Souba worked with an urgent care facility near her mountain home. While she was there, a patient staggered in, suffering from altitude sickness, not an uncommon occurrence for this clinic. Physicians spent considerable time with her, running an IV for hydration, among other things. When Souba checked the billing afterwards, she found the IV wasn’t even mentioned, though the practice could have billed for both its supplies and services.

Why was it missed? IVs weren’t on the practice’s superbill.

Similarly, Souba visited a practice that included only a single code for lesion excision on its superbill, even though are dozens of appropriate codes, including those reflecting whether a lesion is benign or malignant, its size, location, and the number of lesions removed. Undoubtedly, physicians at that practice were losing money every time they circled that one little code instead of understanding the full breadth of options.

Superbills are specifically designed to reflect the most common services and procedures for any given office. You can’t carry around an entire CPT book, after all, so an edited version is necessary. Just realize that your charge ticket reflects the 80 percent of things you do over and over. “You get in your own little world of what you code all the time. So many things are missed,” says Grady. The other 20 percent of the time, your best bet is to write in anything extra or unusual you do. If you can get paid for it, your billing staff should know and can amend the superbill over time.

“A lot of it really comes down to communication and having that physician have someone to go to say, ‘Hey, I did this. Can I bill for it?’” advises Souba. “It’s sitting down and knowing what your physicians are doing.”

It also helps to educate staff about coding, including nurses. “The [nurse] is the one who is in the room with the physician,” Souba points out. If a nurse has to prepare a lab requisition for something biopsied, she should help make sure the biopsy is noted on the superbill.

Billing staff, too, may need more education than they currently get. When Souba worked in private practice, she trained all billers and data entry staff on coding issues common to their specialty. That meant they had the smarts and authority to catch disconnects between diagnosis codes and procedure codes.

For example, in obstetric practices, staff can be trained to look for diagnoses such as sinusitis or hypertension paired with a CPT code for routin<

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