Up to code: A way to ensure your financial health

To keep your finances in shape and your nose clean for the feds, take time to review your coding.

By Larry Stevens, AMNews correspondent. Nov. 5, 2001.

It may not be as inevitable as death and taxes, but it's close. Virtually all doctors' offices will need to review their coding. Understanding what an effective review is, when and how to set it up and how to make it most effective can be important to the financial health of the practice.

There are two types of coding reviews. Procedurally, they are very similar. But in their effects, they are miles apart. The first kind, an audit performed by Dept. of Health and Human Services agents, can be emotionally draining and financially ruinous.

The second, performed voluntarily by the physician practice, has the opposite effect. It can uncover underpayments, improving the practice's finances, and it can help ensure compliance with federal E&M coding rules, rendering the HHS audit, should it occur, less frightening and ultimately less expensive.

A coding review -- which involves comparing patient charts with the codes submitted to HHS or private insurers -- can be an administrative headache. A few subspecialties that perform the same six or seven procedures every day may be able to get away with no or only occasional audits. But for the vast majority of doctors, who have to deal with dozens of codes each day, there is no getting around it.

"There's just too much complexity and confusion in the coding system to assume your practice is doing it right," says Thomas Obade, MD, part of the four-doctor group Orthopedics at Woodbury, in Woodbury, N. J.

The only way to know for sure that all the doctors in the practice, as well as the coding employees, are coding properly is to check the work on a regular basis, says Dr. Obade, who is also chair of the Health Policy and Practice Committee of the New Jersey Orthopaedic Society. [...]