COVER STORY

Demystifying the art of coding

It only seems like it takes magic to code claims accurately. Here's how some practices teach their doctors to circle the right numbers.

By Robert Lowes
Senior Editor

Hire a doctor fresh out of residency training and you may get someone who thinks 99214 is a ZIP code in Spokane—and nothing more. It's up to you to teach that rookie how to circle the right diagnosis and procedure codes on a billing slip. A lot is riding on how well you school him. If he undercodes, practice income suffers. If he overcodes, you risk running afoul of Medicare, which is itching to bust coding scofflaws.

True, some residency programs excel at teaching new doctors picky details like the need for an extended review of systems, among other things, to justify an E&M code of 99214. "But this is atypical," says coding consultant Joy Newby in Indianapolis. "Most doctors come out of residency guessing how they should code." Indeed, many are accustomed to letting a professional coder review their dictation and assign the right number.

So how do you make a competent coder out of a young doctor—or a veteran who should know better? You can send him or her to coding seminars, but that alone won't do the trick. Experts say every medical practice needs to take coding education in-house and make it a career-long experience through frequent chart audits and workshops. And doctors should figure prominently as coding mentors. "Physicians listen to physicians better than anyone else," says Cincinnati internist Douglas Magenheim, medical director of a practice management firm called MediSync.