Do you tend to undercode? You're not alone

A study confirms what many doctors already believe -- they don't give themselves credit for everything they do. That affects fees and, perhaps, quality measurement.

By Robert Kazel, AMNews staff. Nov. 22/29, 2004.

Bill Thrift, MD, a family physician in Prescott, Ariz., says his office frequently undercodes claims after treating patients with multiple, complex problems. He's just anticipating what insurers might reject.

"One of the hardest things for us to do is really charge what we're worth," he said. "We're not aggressive at working the system."

Weary of fighting with insurers, fearful of getting audited by Medicare, or merely unsure about what they can code for -- for whatever reason, many physicians habitually undercode.

A recent study has quantified how much family physicians don't put on their bills. The numbers raise questions not only about undercoding's effect on a physician's income, but also about its effect on quality measurement programs that use claims data to determine how well patients fare, and what sort of cash bonus a doctor might receive as a result.

The coding study, by researchers at the University of Wisconsin Medical School, found that family doctors manage an average of 3.05 problems per patient visit. But they record only 2.82 in the chart, and 1.97 on the bill.

"I have been tending to undercode my visits, and I didn't really realize it until this project," said Cynthia Haq, MD, a family doctor in Madison, Wis., who was one of 29 physicians whose charting and billing methods were scrutinized. "I often undercode ... and write down one or two [problems] when there might be four or five."

Family physicians tend to accept that they advise patients on a variety of issues but will be compensated for only some, knowing insurers will look at some CPT codes but ignore others if they feel additional payment isn't warranted for the same visit. Physicians don't have enough time to record every facet of a visit if the system doesn't reward that kind of thoroughness, Dr. Haq said.