If I really want doctors I know to immediately go into a daze and start thinking about other things they need to do, I start to talk about medical coding.  However, as far as their compensation and pay are concerned, how they code is, and will continue to be, extremely important.

For the non-medical readers, I should briefly discuss what coding is.  Basically, everything a doctor does in terms of procedures, and even the office visit and what is discussed within the office visit itself, has a code.

Insurance companies and the federal government in the form of Medicare and Medicaid use those codes to determine how much work was done.  Most importantly, they use the codes to calculate how much they should paid us doctors for that service.

Each code is associated with what is called a Relative Value Unit (RVU), which means how much work was done and how much it costs relative to other medical work.  Each insurance entity determines a conversion factor which is a unit of money that they will pay per RVU.  Conversion factor times RVU = amount of money paid for that code.

Whew! Writing that summary took a lot our of me, and that was just an overly simplified explanation!

Most doctors consider coding to be beneath them and not that important as it is something relegated to medical record and billing clerks.  This could not be further from the truth.

Bad or inaccurate coding can seriously their salaries whether they are in private practice or in a productivity based salary position.  In addition, if the coding is inaccurate, they the doctors are ultimately responsible to the insurance companies and more dangerously the government for those inaccuracies especially if it results in more money being dispensed than the documentation would allow.

In this area, I have had several mantras. The first and most important is document, document, document.

It is no exaggeration to say that if you don’t document something in a medical setting, it is as if it did not happen both in legal and reimbursement senses especially.  Even if you think you have an iron trap memory, you cannot remember within the torrent of patients you see every day a particular conversation or procedure if it is not documented.  For example, if you talk about smoking cessation with that COPD patient because you do it every time you see that person, you need to document each time AND you need to code for it.

That leads into Mantra #2: Everything you do and document as a medical professional needs to be coded if there is a code for it.  In general, there is a code for all sorts of things, especially because the insurance companies and the feds want to follow such codes to see if you are doing them.

To follow the previous example, if you talk to your patient about stopping smoking but do not code for it even if you have documented it, they do not register you as performing that task.  Nowadays, that can affect reimbursement but also more importantly, going forward that lack of coding can affect your quality ratings, which will eventually affect reimbursement in the coming world of accountable care and value-based care.

Finally, despite what many think about doctors, most doctors undercode.  This means that they choose a code that under-reports what they did.

If this act reduces reimbursement, why do docs do this?  Frankly, one answer is laziness.

As noted previously, many docs do not think of coding as important and frequently pick a middle-of-the road “favorite” code.  One time I reviewed the documentation and coding of the doctors in my own group and found one doctor coded every visit the same.

He used the code 99213 which is the average evaluation and management code most primary care visits for EVERY visit.  When confronted, he had no defense other than convenience and that he did not want to think about how much more documentation he needed to justify the next higher code. Aargh!

I could go on at length about the irresponsibility and unprofessional nature of undercoding in a future blog post.  Suffice it to say, coding for a doctor is very important and should not be relegated to a secretarial function.

In fact, I think that many of the reasons that physicians have lost prestige, financial power and control within the medical infrastructure is that they have ignored important issues of documentation that they thought were beneath them.  For the sake of not only your credibility as a medical professional, but also as a medical professional desiring to attain more wealth in the long term, you should not do the same.

Coding is not beneath you.  It gets results, and it ultimately creates wealth.