© Springer International Publishing AG 2018 419
T.S. Köhler, B. Schwartz (eds.), Surgeons as Educators,
https://doi.org/10.1007/978-3-319-64728-9_23
Evaluation and Management
Documentation, Billing, and Coding
Tobias S. Köhler
Why You Should Care and Why I Care You Care
You have perfected your left-handed knot tying, finally mastered the anatomy of the
inguinal canal, and are ready to start your new surgical career and then comes your
first day of surgery clinic. You do a great job of staying on time, being professional,
and having a solid set of patient encounters. At the end of the day, your nurse hands
you a stack of billing tickets to fill out (and by the way, your first 20 notes will be
audited by the practice manager). Are you prepared? Hint – charging all of your
patients level E3 (established level 3) is not the right answer.
E & M codes are billed in the office, hospital, skilled nursing facility, home
care, inpatient, observation, emergency, and outpatient settings. Codes run levels
1–5. For established codes, one can bill E1, E2, E3, E4, and E5. Similarly for new
and consult patients, one can bill N1–N5 and C1–C5. There are higher levels of
billing for visits that take an inordinate amount of time which we won’t get into.
Tables 23.1 and 23.2 display the difference in relative value units (RVUs) for the
different levels. RVUs are a standardized way of attributing value to medical labor
and how you get paid. Study the tables and memorize the relative increases in value
of the different strata. Also listed here are the time requirements for timed billing
(more on that later).
When I went through orientation for my first job as a surgical attending, I offi-
cially spent more time learning how to properly manage toxic waste than how to
document and bill properly (I’m a urologist, not a nuclear power plant worker).
After a series of billing audits and several heated discussions, I vowed to learn bill-
ing better than my “auditor.” I also planned to get hold of that secret book with all
the answers to the tough billing nuances (still searching by the way). I read a billing
T.S. Köhler, MD, MPH, FACS
Urology, Mayo Clinic, Rochester, MN, USA
e-mail: [email protected]