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Paul Firth Newsletter for 6/29/16

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Newsletter 2016-06-29

I came across an interesting coding case recently and I would like to share it with you all. Fair warning: this is a case specific to pediatrics but there are still some items for everyone to learn.

The not-so-normal newborn

I was called to a C-section. It was a term infant, repeat C/S, born to a G2P1 mother. 1-minute APGAR was 7 but then the infant became apneic, cyanotic, and heart rate dropped to the 60s (5-minute APGAR of 1). I was called at that point. In the delivery room, the infant was bagged approximately 3 minutes and then returned to normal (10-minute APGAR of 8). I arrived as she was being transported up to the nursery.

I examined the infant and read over the mom's chart. I also talked to the OB doctor and dad to get history. She looked great in the nursery. I ordered some labs, a chest x-ray, and kept her in the nursery on a pulse ox. After an hour of saturating in the 99-100% range with no problems, I sent her out to room in with mother. Labs/x-rays were normal. She did fine.

So how to code this? She seems to be a normal newborn that had some sort of event around the time of delivery. I did not attend the delivery or do the resuscitation, so I can't bill for those codes. So I dictated my note. I had a comprehensive history and exam which is pretty typical of all newborns, whether normal or not. So what happens for Medical Decision Making?

I had Extensive Diagnoses and Management options (New problem requiring workup=4 points). For Data Review I ordered labs (1 point), radiology (1 point), summarized the history from someone other than the patient (2 points), and also read my own chest x-ray (2 points). This gives me the 4 points needed for an Extensive Data Review.

You could argue Risk between Moderate (New Problem with uncertain prognosis) or High (life-threatening). However, in this case Risk doesn't really change anything. Medical Decision Making only requires 2 out of 3 of Diagnosis and Management Options, Data Review, and Risk. And as we've already discussed, we have enough for a High level of Decision Making.

When you combine this with the Comprehensive History and Exam, this 'almost normal' newborn now becomes a high level Inpatient Admission (99223) which pays about $170. This is much better than the $83 you would get for a Normal Newborn Admission (99460).

So what is the trick? How do I remember when a normal newborn turns into a level 1, 2, or 3 Inpatient? There is no trick. You do the amount of History, Exam, and Decision Making that is required to manage each individual patient. Then you see how the coding works out. What I've done is develop a template that I use for all newborns and then can quickly see when I'm finished what level of service it should be.

Pediatric Coding Strategies conference

I'm very excited to introduce our first ever Coding conference specific for pediatricians! I will have more information in the following few months, but here are some of the details.

The conference will be held Saturday, October 22nd in Atlanta, Georgia. Sign up online on our website. The DVD course will be available as well and will ship around 10 days after the conference. To pre-order click here.

This course is an advanced-level course intended for audiences that have already taken and internalized the concepts in our Coding Growth Strategies course. Here are a few of the things we will be covering:

  • Charting Pitfalls (the 5-8 things I look for when auditing my own notes. Like we discussed above, what things can I look for that will appropriately increase the level of service)
  • The not-normal newborn (when should you code higher than typical newborn codes)
  • Templates (dozens of templates will be provided to the participants. These are the actual templates I use in my practice. You will also receive pdf files so you can print these yourself. Also the Word documents will be provided so you can easily edit to suit your own practice)
  • Common level 5 patients in pediatrics and how to document them quickly and easily
  • Why almost every sick infant should be appropriately coded a 99214
  • Maximizing reimbursement for Health Maintenance Visits
  • Strategies to increase revenue during the slow Summer slump
  • Utilizing nurses to improve coding and documentation
  • Plus a lot more!

If you are a pediatrician this could be one of the most financially beneficial things you can do for your practice. We will learn to maximize our coding, reimbursement, and fill all of our appointment slots every day. In the next month, I will be sending out a letter to all of our pediatric clients that will discuss in detail everything that we will cover in this conference. Of course I will always offer my money-back guarantee but you can be assured that the information we will cover will be the most helpful thing to your practice since you attended your first Coding Growth Strategies seminar.

That's all for today. Good luck with your practices.

Paul Firth MD 

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