It’s Not Common Sense, It’s Coding

Featured coffee – Boozy Winter Coffee

An auditor told me, ‘it’s common sense’ when I questioned why she failed coders’ E/M levels.

Of course, we’re talking about the 2021 EM levels for office and other outpatient services.

Look, abstracting using the 2021 guidelines has temporarily slowed down production.  That’s to be expected. 

I’d rather have coders slow down, correctly interpret the documentation based upon the new guidelines, and code accurately.  In my experience, when a new policy, procedure, or guideline is implemented, it’s a sure bet that OIG and/or CMS will perform audits the following year. 

The auditor was the E/M guru (before the new guidelines), but she was not auditing based upon the new method of determining levels of Medical Decision-Making or time-based coding.

For the past few months, coders were encouraged to study the new guidelines and the new MDM table and practice coding a few notes each week based upon the January 1^st changes.  Companies and consultants have made a LOT of money hosting webinars. 

And, she missed all of this?  Yes, because she was still the E/M guru in her mind and the changes were just ‘common sense.’ 

She missed the change in coding based upon time for office/outpatient services.  She didn’t know that levels can be coded based on whether or not providers document that counseling and/or coordination of care dominate the encounter.

She missed that Moderate complexity for Diagnostic Procedures Ordered is not Moderate complexity for the Amount and Complexity of Data to be Reviewed and Analyzed as of January 1^st.   

Among other critical changes, she also missed that documentation of Diagnosis or treatment significantly limited by social determinants of health translates to Moderate risk of morbidity from additional diagnostic testing or treatment.

So, it’s not just ‘common sense’; it’s the guidelines.

I’m So Confused

Featured coffee – Dalgona Coffee

Earlier in the week, I saw a commercial on television advertising medical coding and billing.  Nothing new, right?

According to this commercial, you can train at home online in as little as four months (with a small down payment and monthly payments as low as $99.00). 

According to the commercial, no experience is required, and you can earn on average $60k a year.  The company also mentioned that the field “allows for mobility and working remotely.”

We, in the industry, scoff at these types of advertisements.  I know my colleagues, and I do because we know that false dreams are being sold.

Then I noticed the name and I was enraged!  How dare a company use a name and web page address so similar to one of the well established, reputable certifying bodies in the coding industry!

They dare to use a similar name and a cheap cartoonish version of the original logo.

The telephone number is not the same as the legitimate organization. Still, when I clicked on privacy policy at the bottom of the web page, I was taken to the legitimate organization! 

OMG!  What kind of phishing, fake website is this?

Why was I angry? 

There are many coding social groups where new coders voice frustration because they cannot find jobs without experience.  Occasionally, there are good news posts from coders hired without experience. Still, the majority are angry, frustrated, and disillusioned because they felt misled by the promises of obtaining medical billing and coding certifications, making 50k, and working from home.

Now, a company represents itself as one of the reputable credentialing organizations to take money from people with the false promise that they can work in the industry in as little as four months, work remotely, and earn an average of 60k.

There’s absolutely no way the legitimate certifying organization would cheapen their brand or cheapen the certification that has meant so much to so many coding professionals.

• No way this organization would reduce the hard work and dedication that we have put into becoming part of an elite group of respected coding professionals to a certification that can be obtained in as little as four months with absolutely no prior experience.
• No way this organization would promise anyone that they can work remotely.
• No way this organization would quote the average earnings of a newly certified billing or coding specialist as 60k.

Why would the legitimate organization create a commercial with a “similar” name, a cartoonish version of their logo, and direct viewers to a web page with a different telephone number but has links to the legitimate site?

None of it makes sense.

Then, to add to the confusion, I called the number on the web page (deliberately after hours).  The recording directed me to the legitimate organization’s website for more information.

I have too many thoughts to put into words, and I don’t want to get sued.

Yes, I’m a Coding Nerd

Featured coffee – B-52

From the beginning of my medical coding career, I’ve been a self-described coding nerd.

When coding surgical procedures, I read the operative reports, close my eyes, and visualize the procedures.

Do you do that?

Now and then, a coder may be invited by a surgeon to watch a procedure, and it’s an unforgettable experience.

Did you know that you can watch surgical procedures online?

Here’s one of my favorite sites:

https://www.csurgeries.com/

https://medtube.net/

If like me, you sometimes struggle to differentiate between CPT codes and understand the minute differences between similar codes, an excellent resource is the Coders’ Desk Reference for Procedures.