Good Coding Really Does Equal Good Patient and Pocket Outcomes

By Ted A. Arkfeld, DC, MS

Over the past few months, I have been contacted by different doctors around the state who were experiencing either denials from Medicare, BCBS, or needed some additional training on how to use ehrThomas in their office. When reviewing their files I noticed errors in the sequencing of their diagnosis codes. Incorrect diagnosis codes and improper linking of the codes to the CPT codes can cost you money. The most glaring issue that I come across is the incorrect Evaluation & Management Code selection. In one file that was reviewed the doctor did an amazing history, comprehensive examination, but used the 99212 Established Patient Code, where they should have used a 99214 code. A 99212 will pay $47.32, whereas the 99214 would pay $116.01. This is a $69 difference, now what if that occurs twice daily for five days. This equates into a loss of revenue for one week on just this one code of $690. Over a four-week time span, the office is losing $2,700.

In another office, they started to do active rehabilitation but quickly stopped due to denials from BCBS. The problem here was incorrect linking of the diagnosis code to the 97110 Therapeutic exercise service, which normally pays $29.64 for 8-minutes of work. Let's say you have 10 BCBS patients per day, that is $296.40 in additional revenue per day, which is $1482 per week, and $5928 per month. In both of these cases, neither the doctors knew they were losing money due to improper coding.

It seems to me that many doctors do not realize the amazing potential for getting better clinical outcomes and increased revenues by bringing on additional services into their offices. Low tech active rehabilitation is a prime example of a simple procedure that can add almost $6,000 per month in revenue. I have many more revenue ideas that we utilize in our office, some are paid by insurance others are cash only. The patients have no qualms about paying cash for these services because they value what they have to offer. If you are wondering what my Optum profile looks like, I am still a good boy in their eyes.

I know there are doctors all across Michigan who are losing revenue and would like answers, but unfortunately, they do not what questions to ask or where to look. If this sounds like you, please send me an email at drarkfeld@arkfeldchiropractic.com and we can get a phone conference scheduled to discuss your practice.