july 2008

MAXIMIZING YOUR POTENTIAL REVENUE THROUGH ACCURATE CPT CODING

Two of the most common problems affecting revenue are physicians that are not timely in completing their dictation and then not providing the documentation necessary to complete the coding process which leads to physician queries, delayed billing, increased AR, and ultimately negative cash flow issues. Let’s look at lesions and adjacent tissue transfers as an example. We’ve reviewed hundreds of op notes for lesion excisions and it simply states “the lesion was excised.” If you have physicians dictating like this, one option would be to provide them with a cheat sheet and remind them that in order to accurately code these services and for the facility to receive the proper payment there are a number of necessary components that need to be documented. 1) The greatest size (diameter) of the lesion should first be documented. 2) The physician should then indicate the margin that was given around the lesion. The margin is the shortest distance from the lesion to the edge of the skin ellipse. It should read something like this. The lesion was 2cm in diameter and excised in an elliptical fashion with a 2mm margin around this lesion. 2cm + .2cm + .2cm = 2.4cm Physicians also have their own interpretation of the closure codes. Simply stating layered closure does not constitute an intermediate repair. CPT Assistant Aug 06 states that “wounds that require closure of subcutaneous tissue or more than one layer of tissue beneath the dermis should be coded as intermediate repairs.” So as you can see the physician should document closure of subcutaneous tissue and skin to meet the documentation guidelines. Adjacent tissue transfers are another area where considerable amounts of revenue can be lost. These are the components necessary for accurate coding: 1) The size of the primary defect must be known. This is the defect created when a lesion is excised so if the defect is 3cm x 3cm your primary defect is 9 sq cm. Here is where revenue is lost. Most coders would report a flap of 10 sq cm or less. 2) You also must know the size of the secondary defect. This is the defect created during the formation of the flap which is usually the same size of the primary defect or larger. So if the flap being created to fill the primary defect measured 3.2cm x 3.5 cm = 11.2 sq cm. This is the added to the primary defect 9 sq cm + 11.2 sq cm = 20.2 sq cm and reporting of the next highest CPT code which in some instances will lead to a higher reimbursement.