Interesting situation in a Family Practice

Hello Everyone,

I recently came across an interesting situation in a family practice. It seems that inside this multi-physician practice two of the doctors are practicing what essentially can be termed as geriatric medicine.

The patients are all on Medicare and each have multiple chronic conditions.

The oddity I find is that the physician documentation supports the level of care they are providing as well as the level of service they are billing (99214).

Unfortunately during a recent internal benchmark of the practice it was discovered that the e/m distribution was heavily weighted to the level fours. Almost to the exception of everything else.

Abusive? Possibly. When the data was run against a geriatric taxonomy the numbers line up almost perfectly. When run against a family practice taxonomy they are near 100% double the national average for a family practice.

I suspect these physicians are an audit target but looking at there documentation they score level fours all day long. Changing their t-code is not a possibility.

Any thoughts or advice?

The documentation is always extended or complete hpi based on multiple medical problems, the MDM is always moderate based on the number of diagnosis codes being managed at each encounter along with the prescription drug management. Exacerbations sometimes push the risk to high.

Exams continually score detailed even though when they do not there is enough else where (hpi and mdm)

__________________

Peter Davidyock CPC CPMA

2014-2017 AAPCCA Board of Directors

Region 3 Virginia, West Virginia, Kentucky, North Carolina, South Carolina

Peter.Davidyock@aapcca.org

Coastal Coders Conway South Carolina

Come to the edge he said

Interesting situation in a Family Practice