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conscientious decision not a blind one based on ignorance. I personally feel the fear
of audit and punishment is greatly exaggerated and irrational. Ethical providers
with logical justification for their billing will be just fine. The government would
much rather focus on people double billing, billing without being present, billing
without proper documentation, or billing by gaming the system (e.g., by doing elab-
orate histories and physical exams when medical decision-making and risk are
low).
Conclusion
Congrats on reading to the end. Most people start reading about billing and have the
same reaction I have to embryology lectures – gloriously refreshing somnolence.
Despite its soporific qualities, my knowledge of billing has greatly benefited my
surgical career in many ways. I will elaborate since you may still be on the fence.
My patient care is improved because my notes are more concise and contain only
the information necessary for excellent patient care and the billing requirement
minimums. Medicolegally, I do not have concerns about over- or under-billing since
I know the rules extremely well. I have been able to teach many resident and medi-
cal students (and staff) the billing basics. Many of them have run with the little bit
of knowledge I gave them and created their own billing templates and cheat sheets.
Research opportunities abound in all of your patient encounters. You can easily
incorporate validated questionnaires that cover all of the elements required for the
HPI. My notes are cleaner, and thus the information and communication with refer-
ring MDs have improved. Compared to my peers who primarily bill E3 appoint-
ments for follow-ups (0.97 RVU), I am on average 50% more efficient by
appropriately billing E4 (1.5 RVUs). This obviously increases my take-home pay
and leaves me with more free time to spend with my family. Finally, my daughters
and I roughly estimate that I have saved 7 ½ acres of rain forest over my lifetime
because my notes are shorter.
Self-Check Quiz
- List the three core elements of all E & M notes? Which is the trump element?
- Name the three components to medical decision-making? What is the trump
MDM component? - Besides having seen the patient within a practice for 3 years, what is the funda-
mental documentation difference between established and new patient visits? - True or false: The middle-level billing of the three categories is used to deter-
mine MDM billing. - True or false: For history billing, the middle-level billing of the three categories
is used to determine history component billing. - For overall billing, the middle-level billing of the three pillars determines the
submitted billing charge.
T.S. Köhler