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How to Effectively Teach Evaluation and Management in Under One Hour, written by Stephanie L. Jones, CPC-E/M
A visual reference and how it ties into a level of code can be very helpful when describing this aspect of
code selection. The chart below is one version:
NUMBER OF DX and MANAGEMENT OPTIONS
� Minor =1 ea. (max 2)
� Est. stable/improved = 1 ea.
� Est. worsening =2 ea.
� New problem, w/o workup =3 ea. (max 1)
� New problem, w workup=4 ea.
Example
Type
New or
Established
Outpatient and
Consult Patient
LEVEL
Minimal:
• 1 point as totaled from above
Uncomplicated, non-infected insect bite
Straight-forward
1 & 2
Limited:
• 2 points as totaled from above
Controlled HTN and tachycardia
Low
3
Moderate:
• 3 points as totaled from above
New patient with migraine headaches
Moderate
4
Extensive: • 4 + points as totaled from above
Patient seen today for f/u on OA knees and 1 year THR check. C/O knee pain. MRI ordered for possible meniscus tear. R/O symptom of osteoarthritis and sprain
High
5
AMOUNT AND/OR COMPLEXITY OF DATA TO BE REVIEWED
The Amount and Complexity of Data to Be Reviewed is measured by the need to order and review tests
and the need to gather information and data. Planning, scheduling, and performing clinical Labs and
tests from the CPT® Medicine and Radiology sections are indicators. The need to request old records or
to obtain additional history from someone other than the patient (for example. family member, care
giver, teacher, etc.) is credited in this section. Also documented are discussions with the performing
physician about unusual or unexpected patient results.
How to Effectively Teach Evaluation and Management in Under One Hour, written by Stephanie L. Jones, CPC-E/M
If a physician needs to make an independent visualization and interpretation (for example, MRI film,
gram stain, etc.) and he or she is not billing separately for this service, it too is credited to this
component of code selection.
A visual reference and how it ties into a level of code can be very helpful when describing this aspect of
code selection. The chart below is one version:
AMOUNT/COMPLEXITY OF DATA
One Point Each: � Clinical Labs test ordered or reviewed � CPT® Medicine Section Test- ordered or reviewed � CPT® Radiology Section Test- ordered or reviewed � Discuss patient results with performing or consulting physician � Decision to obtain old records or additional history from other
than patient Two Points Each: � Review and summarize data from old records or additional
history gathered from other than patient � Independent (2nd) interpretation (from another physician) of an
image, tracing, specimen (not just review of the report)
• Two or more self-limited or minor problems • One stable chronic illness, eg well controlled hypertension or non-insulin dependent diabetes, cataract, BPH • Acute uncomplicated illness or injury, eg, cystitis, allergic rhinitis, simple sprain
• Physiologic tests not under stress, eg, pulmonary function tests • Non-cardiovascular imaging studies with contrast, eg, barium enema • Superficial needle biopsies • Clinical laboratory tests requiring arterial puncture • Skin biopsies
• Over-the-counter drugs • Minor surgery with no identified risk factors • Physical therapy • Occupational therapy • IV fluids without additives
Low 3
• One or more chronic illnesses with mild exacerbation, progression, or side effects of treatment • Two or more stable chronic illnesses • Undiagnosed new problem with uncertain prognosis, eg, lump in breast • Acute illness with systemic symptoms, eg, pyclonephritis, pneumonitis, colitis • Acute complicated injury, eg head injury with brief loss of consciousness
• Physiologic tests under stress, eg, cardiac stress test, fetal contraction stress test • Diagnostic endoscopies with no identified risk factors • Deep needle or incisional biopsy • Cardiovascular imaging studies with contrast and no identified risk factors, eg arteriogram, cardiac catheterization • Obtain fluid from body cavity, eg lumbar puncture, thoracentesis, culdocentesis
• Minor surgery with identified risk factors • Elective major surgery (open, percutaneous or endoscopic) with no identified risk factors • Prescription drug management • Therapeutic nuclear medicine • IV fluids with additives • Closed treatment of fracture or dislocation without manipulation
Moderate 4
• One or more chronic illnesses with severe exacerbation, progression, or side effects of treatment • Acute or chronic illnesses or injuries that pose a threat to life or bodily function, eg multiple trauma, acute MI, pulmonary embolus, severe respiratory distress, progressive severe rheumatoid arthritis, psychiatric illness with potential threat to self or others, peritonitis, acute renal failure • An abrupt change in neurologic status, eg seizure, TIA, weakness, or sensory loss
• Cardiovascular imaging studies with contrast with identified risk factors • Cardiac electrophysiological tests • Diagnostic Endoscopies with identified risk factors • Discography
• Elective major surgery (open, percutaneous or endoscopic) with identified risk factors • Emergency major surgery (open, percutaneous or endoscopic) • Parenteral controlled substances • Drug therapy requiring intensive monitoring for toxicity • Decision not to resuscitate or to de-escalate care because of poor prognosis
High 5
How to Effectively Teach Evaluation and Management in Under One Hour, written by Stephanie L. Jones, CPC-E/M
– 0-10 Minutes: Medical Necessity: Determine Clinical Examples
– 11-20 Minutes : History Taking: HPI, ROS, PFS
– 21-30 Minutes: Exam, ‘95 Subjectivity and Medical Necessity
– 31-40: MDM, No of Dx, Data, Risk
– 41-50: Put it together:
• Learning Types,
• Physician Note Example, Physician Form Example,
• Teaching Tips
– Conclusion 9:00-9:15: Workshop Introductions
10:15-10:30: Rest Room Break
Noon: Dismissal
→
3
Set the Stage for Coaching
• Discuss physician concerns
– Don’t volunteer sympathy for concerns you think the physician may have–he or she may not have thought of them
• Be understanding, polite and respectful – No matter how much you know about coding, compliance, nursing
or the healthcare marketplace ---You are not the doctor
• Overcome objections– Be ready to counter complaints
• Be prepared– Whenever possible, use examples from the physician’s own work
→
2
4
Concerns
Payment Ambiguity Fear
Unease about being paid properly
for the value of the service
Concerns regarding subjective, hidden or
unknown aspects of proper coding
Consequences for defensive under-coding
or emotional over-coding
→
5
Payments are important to physicians.
��������The level of service coded is based on how The level of service coded is based on how
sick a patient is and meeting documentation sick a patient is and meeting documentation requirementsrequirements
• Payment and coding must be unrelated
– They just need to be addressed by other
means, such as contract re-negotiations
Concerns
→
6
Ambiguity frustrates physicians.
��The level of service coded is based on how The level of service coded is based on how sick a patient is and meeting documentation sick a patient is and meeting documentation requirementsrequirements
• It can be subjective
– “Within the next hour you’ll have the tools you need to enjoy successful outcomes anyway”
Concerns
→
3
7
Concerns
Fear slows down physicians.
��������The level of service coded is based on how The level of service coded is based on how sick a patient is and meeting documentation sick a patient is and meeting documentation requirementsrequirements
• There is no one better qualified to determine medical necessity than a physician
• During the next hour, you’ll learn how to use your clinical knowledge to quickly ascertain the correct code and what you need to document in order to support the services you render
→
8
Overcoming Objections
Reverse the Objection
AddInfo
Be Positive
Ask Questions
→
9
Overcoming Objections
• I don’t have time for this!
– Add information
• With cuts in fees from Medicare and private insurers, many doctors must see more patients to maintain their incomes
– You have less time
• This training takes less than an hour and may ultimately save you time (and money)
→
4
10
Overcoming Objections
• No one is going to audit me!
– Ask questions! • Can you afford to be wrong?
• How can you be sure you are right?
• Would you like to never under-code?
• Would you like to not have to ever worry about it?
The Way it WAS The Way it IS
$���� claims in ���� quantity =
cost prohibited review
����Outsourcing and technology =
���� Cost of review
Hospital and Surgery Claims Auditsproduce high ROI
Pressure to collect and correct
$20B+ in abusive E/M claims
E/M Claims are cost prohibitive to
Audit
E/M Claims audits now produce
ROI
→
11
• Most physicians will readily understand:
– Levels 3-5* are reserved for “sick” or injured patients
– Lower levels are for patients who present with
minor and/or well controlled condition/s
*This presentation refers to levels of service for outpatient and consult visits.
0-10: Medical Necessity
→
12
Determine Examples:
*This chart should only be used for the purpose of guiding discussion: it references new outpatient and consult visits →
5
13
Clinical examples: • AMA vignettes
• Opinions by peers
• The CMS Table of Risk
• The physician’s work
– “Describe to me the most common patient complaint(s) you see…”
• Tip: Many times this will represent a level 3
– What would make you more concerned? – What makes you decide how soon a patient should
return for a follow up visit or see a specialist?– What would make you the most concerned?
• What would your peers say?
Determine Examples:
→
14
Determine Examples:
– Example Level 1: Patient with simple abrasion, dressed. F/U PRN
– Example Level 2: Patient returns for 4 year follow up visit hip replacement, no complaints
– Example Level 3: 14 year old with first degree ankle sprain, Rx rest and OTC meds
– Example Level 4: Patient with painful total hip 1 year post replacement, worsening x 6 months
– Example Level 5: Femur and Hip Fracture in 80 year old diabetic brought in from the parking lot after hit and run while walking in
→
Ask questions:
-- You’re the medical expert: What other examples of injuries or illness fall in this level?
-- Clinically, what makes this problem a level 4 instead of a level 3?
Give examples the physician will personally relate to and can expand on:
Examples are made for the purpose of discussion only on new patients and may not always support the level cited above *
15
11-20: History Taking
• Now that the physician is comfortable identifying a level of service, he or she needs to learn what elements of service are needed in the documentation in order to support it
• The history component has subjective aspects in both sets of guidelines
– The DGs are just guidelines. • There are multiple audit forms used in the industry that
conform to the DGs but that can also produce different outcomes
– Marshfield Clinic model– TrailBlazers model
• A coach must assist a physician in developing his or her personal objectivity so that a logical and solid argument can be made for the documentation and the correct use of a code
– This is accomplished by pointing out areas of subjectivity and special circumstance
→
6
16
Special Circumstance
• Patient is unable to give a history• (ROS) and (PFS) History taken from an earlier encounter
– May not be medically necessary
• A comprehensive service may be performed and documented but…– A comprehensive service is not always medically necessary or billable
• Unless Preventive, a Chief Complaint (CC) must be identifiable – This is the first step in establishing medical necessity
• Subjective aspects…– Reviewer A may argue with Reviewer B that an element of (HPI) is a
“quality” versus an “associated sign or symptom,” or other (HPI) element – Reviewer B may state that the documented “NKDA” constitutes an
element of ROS or conversely an element of Past history.
– Any free-form text is to some degree interpretive. This holds true with physicians’ notes. Since coding relies on counting subjective elements, the correct interpretation requires consistency, citable references, a logical argument and - ultimately - medical necessity.
→
17
HPI
• Be prepared to discuss examples of HPI and to answer questions but avoid excessive instruction –much of it is like teaching an expert pianist basic scales
• Location: For example “chest” pain, sore “knee,” etc. Conversely, examples such as “COPD,” “Diabetes,” and “Hypertension” are not locations - these are “chronic conditions” Note: To credit chronic conditions use the ‘97 DG or one of the other elements of ‘95 HPI (such as Severity: i.e., CC = Return BP check, patient states it has been running 120/80 at Walgreen’s self service cuff. )
18
HPI
• Severity: A statement of degree or measurement regarding how bad it is… that it is improved, it is extreme pain, “Blood Sugar is 200,” feeling “better,” pain is bad enough “that the pt can’t sleep” etc.
• Timing: A measurement of when or at what frequency; i.e. “intermittent,” “constant,” in the “morning,” lasted “5 minutes,” “occasional,” “on and off,” etc.
• Associated signs and symptoms: Any associated or secondary complaints.
• Modifying factors: Anything that makes the problem better or worse, a factor that changes, improves, or alters the problem. For example, improved “with Tylenol,” worse “when standing,” better “when resting,” “calms down when mother feeds her.”
– Subjectivity Alert: Medication may be a modifying factor when it changes, improves, or alters the problem. Otherwise, it is most often credited to PAST Hx. Some auditors will credit medications that were used in an unsuccessful attempt to modify the condition as a “modifying factor.”
→
7
19
HPI
• Context: What the patient was doing, the environmental factors/circumstances surrounding the complaint, for example, “while sleeping,” “MVA,” “slipped and fell,” after “eating peanuts,” “while dusting,” “when arguing with his wife,” etc.
• Duration: A measurement of time regarding when the complaint first occurred. For example, began “in childhood,” “since 1995,” first noticed “two weeks” ago, “symptoms x 3d,” etc.
• Quality: Any characteristic about the problem and/or expresses an attribute. For example: how it looks or feels; for example. “green” phlegm, “popping” knee, “dull” ache, “sharp” pain, “metallic” taste, etc.
→
20
ROS
• The ROS may be supplied in any format: separate patient intake or questioner form within the HPI
• ROS elements typically reference signs and symptoms, of which both positive and negative responses are considered. Auditors commonly watch for indications “pt denies fever,” “upon further questioning the…”)
• ROS should be medically necessary. – It may be considered necessary to
obtain a complete ROS when a patient presents as an initial new patient.
– It may not be considered necessary to repeat a complete review on every follow-up.
→
21
ROS
• There is a fine line between the signs and symptoms that a patient shares in the HPI and those obtained via the ROS. – If the documentation reads:
• “Patient states that her hip has been painful since her fall last week.” Documentation is HPI.
– If, on the other hand, the documentation reads: • “Patient states that her hip has been painful since
her fall last week. – She denies any other musculoskeletal
complaint.” There is a distinct documentation that shows the HPI and also a separate musculoskeletal review of system occurred.
→
8
22
PFS
• Past history: The patient's past experiences with illnesses, operations, injuries and treatments, and medications; If a patient presents for follow up on a chronic condition both HPI and Past History would be considered. Positive findings of past diagnoses and current medication discovered on ROS would be considered.
• Family history: A review of medical events in the patient's family, including age at death, diseases which may be hereditary or place the patient at risk.
• Social history: An age-appropriate review of past and current activities, for example occupation, smoking, alcohol use (EtOH), sexual activity, marital status, etc.
→
23
Hx
HPI:
1.Location
2. Quality
3. Severity
4. Timing
5. Context
6. Modifying Factors
7. Duration
8. Associated S&S
ROS:
1. Constitutional
2. Eyes
3. ENMT
4. Cardio
5. Respiratory
6. GI
7. GU
8. MS
9. Skin
10. Neuro
11. Psych
12. Endo
13. Hemat/Lymp
14. Allergic/Immuno
PFSH:
1. Past
2. Family
3. Social Type
New or
Consult
Patient
LEVEL
Est
Patient
LEVEL
Brief:
1
N/A N/A Problem
Focused 1 2
Brief:
1
Problem Pertinent:
�1
N/A Expanded
Problem
Focused2 3
4
or
1997:
status of 3 chronic
Extended:
�2
Pertinent:
�1Detailed 3 4
Extended:
�4
or
1997:
status of 3 chronic
Complete:
�10
Complete:
�3 or
�2+ (Est.) Comp 4 or 5 5
24
Hx
HPI:
1.Location
2. Quality
3. Severity
4. Timing
5. Context
6. Modifying Factors
7. Duration
8. Associated S&S
ROS:
1. Constitutional
2. Eyes
3. ENMT
4. Cardio
5. Respiratory
6. GI
7. GU
8. MS
9. Skin
10. Neuro
11. Psych
12. Endo
13. Hemat/Lymp
14. Allergic/Immuno
PFSH:
1. Past
2. Family
3. Social Type
New or
Consult
Patient
LEVEL
Est
Patient
LEVEL
Brief:
1
N/A N/A Problem
Focused 1 2
Brief:
1
Problem Pertinent:
�1
N/A Expanded
Problem
Focused2 3
4
or
1997:
status of 3 chronic
Extended:
�2
Pertinent:
�1Detailed 3 4
Extended:
�4
or
1997:
status of 3 chronic
Complete:
�10
Complete:
�3 or
�2+ (Est.) Comp 4 or 5 5
CC: knee painPt states “I fell off a step stool about four hours ago and landed on my knee.
It has been tight, red and painful. It’s swollen”. Pt denies motor disturbances including balance, coordination. Pt takes Zoloft 25 mg QD.
9
25
21-30: Exam
• Best results come when you focus on only one of the DGs
– This avoids overwhelming the physician
• Know what documentation guidelines are best suited for your
physician
– Is there an internal policy mandating the use of one or the other?
– Which set will this physician benefit the most from?
• Standards (and individual style) of practice often result in repeating patterns of exam for the same kind of complaints
– Take copies of the ’97 DG examination and ask the physician to
highlight the elements he or she would perform for his or her five
most common complaints
• Even if you are teaching the ’95 DGs, this gives the physician a visual idea of what’s required in documentation for a given
level of service
→
26
Subjectivity
• The examination component is the least subjective aspect of the DGs
• There are only two readily identifiable grey areas:
– Expanded Problem Focused exam vs. a Detailed exam • Both require at least two body areas and/or systems with a
“limited” or an “extended exam”. – Comprehensive single system exam
• A single system exam is “complete”.
• Ask questions to help a physician develop objectivity
– Was a more extended exam medical necessary?
– Would peers agree that more than a limited exam was documented?
• Be prepared to give an opinion
– You may want to refer to the ‘97 DGs for comparative value→
27
Exam
• NEVER base training on getting to a higher code because of “just one more bullet”
��������The level of service coded is based on how sick a The level of service coded is based on how sick a
patient is and meeting documentation requirements.patient is and meeting documentation requirements.• Ask:
– “What would make you want to perform a more detailed
exam for one patient versus another?”
– “Would the majority of your peers agree with you that this was necessary?”
10
28
95 DGs
→
Body Areas:
� Head/Face
� Neck
� Back� Abdomen
� Genitalia
� Chest/axillae/breast
Systems: � Constitutional
� Eyes
� Ears, nose, mouth and throat
� Cardiovascular� Respiratory
� Gastrointestinal
� Genitourinary
� Musculoskeletal� Skin
� Neurologic
� Psychiatric
� Hematologic, lymphatic immunologic
Number of Areas/Systems
Examined Type New or Consult Patient LEVEL Est. Patient LEVEL
� 1 PF 1 2
� 2 LimitedEPF 2 3
� 2 ExtendedDetailed 3 4
� 8 (Systems only) Comprehensive 4 or 5 5
29
95 DGs
→
Body Areas:
� Head/Face
� Neck
� Back� Abdomen
� Genitalia
� Chest/axillae/breast
Systems:
� Constitutional� Eyes
� Ears, nose, mouth and throat
� Cardiovascular� Respiratory
� Gastrointestinal
� Genitourinary
� Musculoskeletal� Skin� Neurologic
� Psychiatric
� Hematologic, lymphatic immunologic
BP 120/80. The patient’s gait is
normal. Some tenderness. Thereis no knee effusion. The medial and
lateral collateral ligaments are
intact.
Number of Areas/Systems
Examined Type New or Consult Patient LEVEL Est. Patient LEVEL
� 1 PF 1 2
� 2 LimitedEPF 2 3
� 2 ExtendedDetailed 3 4
� 8 (Systems only) Comprehensive 4 or 5 5
30
31-40: MDM
• Different audit forms vary dramatically in this component and may produce different codes– Before coaching, obtain the audit form used by the physician’s
local Medicare carrier
• Code selection is based on the relative level of difficulty in making a diagnosis and by the status of the problem (controlled versus worsening.)
• The amount of work involved in reviewing the necessary data and the immediate risk of the patient are very important aspects of documentation
11
31
No of Dx
- Minor =1 ea. (max 2)
- Est. stable/improved = 1 ea.
- Est. worsening =2 ea.
- New problem, w/o workup =3 ea. (max 1)
- New problem, w workup=4 ea.
Example Type
New or Established
Outpatient and Consult
Patient LEVEL
Minimal: • 1 point as totaled from above
Uncomplicated, non-infected insect bite
Straight-forward 1 & 2
Limited:• 2 points as totaled from above
Controlled HTN andtachycardia
Low
3Moderate:• 3 points as totaled from above
New patient with migraineheadaches
Moderate
4Extensive: • 4 + points as totaled from above
Patient seen today for f/uon OA knees and 1 yearTHR check. C/O knee pain.MRI ordered for possiblemeniscus tear. R/Osymptom of osteoarthritisand sprain
High
5
32
DataOne Point Each:� Clinical Labs test ordered or reviewed� CPT® Medicine Section Test- ordered or reviewed
� CPT® Radiology Section Test- ordered or reviewed � Discuss patient results with performing or consulting
physician
� Decision to obtain old records or additional history from other than patient
Two Points Each:� Review and summarize data from old records or
additional history gathered from other than patient
� Independent (2nd) interpretation (from another physician) of an image, tracing, specimen (not just review of the report)
Type
New or Established
Outpatient and
Consult
Patient
LEVEL
Minimal: • 1 point as totaled from above
Straight-forward 1 & 2
Limited:• 2 points as totaled from above
Low 3
Moderate:• 3 points as totaled from above
Moderate 4
Extensive: • 4 + points as totaled from above
High 5
33
RiskCMS TABLE OF RISK
Overall Risk between planned encounters
Any example listed from a row below for any of the three columns will equal a level of risk.
• Two or more self-limited or minor problems• One stable chronic illness, eg, well controlled hypertension or non-insulin dependent diabetes, cataract, BPH• Acute uncomplicated illness or injury, eg, cystitis, allergic rhinitis, simple sprain
• Physiologic tests not under stress, eg, pulmonary function tests• Non-cardiovascular imaging studies with contrast, eg, barium enema• Superficial needle biopsies• Clinical laboratory testsrequiring arterial puncture• Skin biopsies
• Over-the-counter drugs• Minor surgery with no identified risk factors• Physical therapy• Occupational therapy• IV fluids without additives
Low 3
• One or more chronic illnesses with mild exacerbation, progression, or side effects of treatment• Two or more stable chronic illnesses• Undiagnosed new problem with uncertain prognosis, eg, lump in breast• Acute illness with systemic symptoms, eg, pyclonephritis, pneumonitis, colitis• Acute complicated injury, eg, head injury with brief loss of consciousness
• Physiologic tests under stress, eg, cardiac stress test, fetal contraction stress test• Diagnostic endoscopies with no identified risk factors• Deep needle or incisional biopsy• Cardiovascular imaging studies with contrast and no identified risk factors, eg arteriogram, cardiac catheterization• Obtain fluid from body cavity, eg, lumbar puncture, thoracentesis, culdocentesis
• Minor surgery with identified risk factors• Elective major surgery (open, percutaneous or endoscopic) with no identified risk factors• Prescription drug management• Therapeutic nuclear medicine• IV fluids with additives• Closed treatment of fracture or dislocation without manipulation
Moderate 4
• One or more chronic illnesses with severe exacerbation, progression, or side effects of treatment• Acute or chronic illnesses or injuries that pose a threat to life or bodily function, eg multiple trauma, acute MI, pulmonary embolus, severe respiratory distress, progressive severe rheumatoid arthritis, psychiatric illness with potential threat to self or others, peritonitis, acute renal failure• An abrupt change inneurologic status, eg, seizure, TIA, weakness, or sensory loss
• Cardiovascular imaging studies with contrast with identified risk factors• Cardiac electrophysiological tests• Diagnostic Endoscopies with identified risk factors• Discography
• Elective major surgery (open, percutaneous or endoscopic) with identified risk factors• Emergency major surgery (open, percutaneous or endoscopic)• Parenteral controlled substances• Drug therapy requiring intensive monitoring for toxicity• Decision not to resuscitate or to de-escalate care because of poor prognosis
High 5
12
34
41-50: Put it together
• Answer questions even if they are “out of order” with emphasis on:– 1st Medical Necessity
• This helps bring clinical relevance
– 2nd Documentation Requirements
• Be prepared to have many questions fired at once:
– Can you just tell me what I need for a Level 3?– What makes it a Level 4?
– When do I know it is a Level 5?
– This patient has an ACL tear - what E/M level is that?• “It all depends on how ‘sick’ the patient is”
– Let’s review clinical examples so you know how to define that
– Then let’s review this quick reference form so you can easily see what documentation is necessary
→
35
Learning Types
Be prepared to adjust for different learning styles:• Audio:
– Learn best from listening to your instruction – Give lots of verbal details and ask the physician to add to them
– Review forms together aloud
• Visual learners:– Skim the reference tool prior to starting so that the physician has
a general understanding
– Use visual reference forms continuously during coaching– Use highlighter pens in different colors to make different points
– Eye contact is important
• Kinesthetic:– Compare one of the physician's notes with a quick reference
form
• As you review it together: Ask the physician to circle salient points on note and highlight them on the reference form
→
36
Note
13
37
Form
99213
38
Teaching Tip
• Be aware of the time allotted to make your salient points but be flexible with questions
– If you feel you are getting off course:
• “I’ll be happy to discuss that in detail with you. Let me first give you the general points you need so that we can make the best use of your time today.”
• Be willing to rearrange delivery of the information in order to answer questions
• Address the physician’s concerns openly, directly and with respect
• A physician may be frustrated; a good coach recognizes that these emotions are not meant personally
→
39
Teaching Tip
• It is okay to say, “I don’t know”
• No matter what you prepare for, a question will almost always come up that you have not considered before
– To some people, being a teacher -- or a leader -- means appearing as though you have all the answers. Any sign of vulnerability or ignorance is seen as a sign of weakness. Those people can make the worst teachers.
– Sometimes the best answer a teacher can give is, “I don't know." Instead of losing credibility, she gains trust, and that trust is the basis of a productive relationship.
– Parker Palmer, longtime instructor and author of “The Courage to Teach: Exploring the Inner Landscape of a Teacher's Life” (Jossey-Bass, 1997).
→
14
40
Conclusion
• Empower the physician with the understanding that the nature of the presenting problem and the severity of the patient’s illnesses are the most important factors of code selection
– The physician’s medical training makes him or her an expert
• Documentation must support the services rendered and the code selection
• Sympathize with the physician’s mindset: Coding and billing affects a physician’s livelihood
• Be prepared to overcome objections• Know how to best organize coaching based on the personality
type of the physician• Be aware of the time allotted to make your salient points but
flexible with questions • Be willing to rearrange delivery of the information in order to
answer questions• Address the physician’s concerns openly, directly and with
respect • A physician may be frustrated; recognize that it is not personal
41
Questions?
Written by: Stephanie Jones, CPC-EM, VP Member Services AAPC 800-626-2633 x 143 [email protected]