Clancy notes that the most common failing in physician coding is in the area of prevention and counseling. Most providers use the straightforward E&M codes and frequently forget to add diagnostic codes, she says. Physician practices "almost always" neglect to put counseling codes on their claims, she says.
Hudson pays for medical reconciliation after an ED visit and after hospitalization because it has been shown to significantly reduce readmissions, but the codes are underused, Clancy says. Another example is counseling for antibiotics related to bronchitis, which Hudson pays for.
"In our area, with the focus on quality, paying attention to this kind of thing could make a significant difference in the bonus you receive," Clancy says. "We pay very significant bonuses and we're just a Medicaid plan. If you're in any shared savings arrangement or pay-for-performance with your managed care company, you should explore some of these options and ask the managed care company to come in and discuss the code set. Those payments could be $100,000 or more, depending on volume and your negotiated rates."