The following Professional Practice Activity (PPA) asks you to evaluate the coding in a Sample Encounter Form. Read the instructions below to successfully complete this assignment.
You have just been hired as a coding manager by a mid-sized group practice clinic. Recently, the clinic had an external audit that went poorly, with numerous coding and billing errors noted. Therefore, one of your first priorities is to review the encounter form the clinic is using.
Each procedure code on the encounter form must be reviewed for description changes, code deletions, or code revisions. You should assume that the encounter form hasn’t been thoroughly reviewed for several years. Remember, the encounter form will not have every code possible, but only the codes the clinic commonly uses.
If you find a code that needs to be updated, take the following steps in your Word document:
Identify which code is out of date. List the code number and description. For example, let’s assume the first code listed is outdated. Write the following details from the form to identify the code you are updating:
99201 New Patient, Level I
Next to this, write in the new code from your edition of CPT:
99201 New Patient, Level I: NEW CODE = xxxxx (fill in correct code)
Recognize that E/M Codes and HCPCS Level II codes are listed, but you do not have to verify them.
Since you will need to report your findings to the physicians for approval before any changes are made to the encounter form, you are also required to explain the importance of correct coding with the encounter form and the implications of having incorrect codes on the form. Compose a short essay discussing the importance of quality reviews when encounter forms are used. Be sure to give concrete examples in your writing. Your explanation should be at least 2-3 paragraphs and your report should be submitted using APA formatting.