A few weeks ago I passed along information about a collaboration between APMA, the Department of Health and Human Services, and America on the Move designed to get people walking.  Tomorrow (April 2nd) is the day designated as National Walk to Work Day, and if you can't walk to work, they urge that you walk at work, or after work, or any time you can.  This seems like a good "kick-off" to April as Foot Health Awareness Month, and a potential "foot in the door" to propose some foot health lectures at schools or workplace health fairs or the like. 

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With this week's Coding Question and Answer, Dr. Phill Ward has provided an "Audit Sheet" for the Medical Decision Making part of the Evaluation and Management (E/M) coding process.  Because it is five pages long, I have posted it on the FootZine web site for you to download and print.  We appreciate the amount of thought and effort that obviously went into the creation of this document, and Dr. Ward's willingness to share it.

 ~ Gayle

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"Happy is the man who has acquired the love of walking for its own sake!"  -  W.J. Holland

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From:  Tim Messmer, DPM
re:      Co-Pays for Follow-up Visits  (Volume 71)

Hi Gayle!

Regarding a post I read in this newsletter on co-pays.  Susan Weeks said co-pays are NOT to charged to patients coming in for po [post-op] FU visits.  That is not necessarily true with all plans.  I know we have some insurances which require the patient to pay a co-pay EVERY TIME he/she walks through my doorway, whether they are in a global period or not.  Each plan has its specifics.  I urge everyone to read the fine print on these plans, since missing $20 for 3-4 po visits can add up to quite a bit of additional income.

Tim
Tim Messmer, DPM
Anacortes, WA

Hi Gayle,

I am a Certified Podiatric Medical Assistant employed by the Foot and Ankle Center as Office Manager here in PA.  I have 14 years of Podiatric experience.

My husband has taken a position in Springfield, Ohio.  I will be moving to Springfield, Ohio June 14, 2004.  I will be looking for employment in a Podiatry office.  Should anyone know of an open position, please contact me at dafeety@juno.com
I would appreciate it very much.

Sincerely
Judy Jackson, PMAC

Notices of positions wanted or positions available, as well as other "classified" information, are welcome. They are posted at the FootZine web site's Networking page. Have a look at http://www.footzine.com/FZ_6.htm

*_* Editor's Note *_*
This week's question was edited for clarity.

The Question:

From:  Eileen B
re:      Medical Decision-Making

Hello - I have a coding question pertaining to Evaluation and Management services.
I am doing a self-study course and am struggling with the medical decision making component.
I have taken a medical terminology class and am able to identify a disease by definition but do not know how to come to a conclusion for the different levels of the medical decision making component in reference to the severity of the disease, such as self limited or life threatening.

How would I know if a condition is one in which the body can correct itself or something more severe or even life threatening? The way I see it this is something only a doctor would know, yet in all the documentation I can find on medical coding it appears this is the responsibility of the Medical Coder to extract this information from the medical documentation and assign a certain level of medical decision making.

Please help me as I am very frustrated because I am able to get the concept of all other components of e/m coding but just can't get passed the MDM component.

Eileen B

The Answer:

EileenB,
 
The best way to answer this question is to forward to you an audit sheet that goes over the MDM component which I will do through Gayle.

Your specific question deals with the type of diagnoses and the treatment options.  If you think about MDM as the three following areas it makes more sense.

1. What's wrong with the patient.  How many and what type of diagnoses are there for this patient on this visit.
2. How much stuff did I have to look at to figure out what was wrong. Did I review imaging studies, old charts, talk with another Dr about this patient.
3. Based on what I am going to do to this patient what is their risk. This is just a reference table that lists the type risk to the patient based on type of diagnosis, tests ordered and procedures done.

I would be happy to talk to you about MDM if you want to.
Phill Ward, DPM

*_*  Dr. Ward has shared his Audit Sheet with us, and you will find it through a link on the FootZine web site's coding page.  Just look for it at the bottom of this Q & A on the Coding Page.  *_*

Crystal-Clear Coding tips by Dr. Ward are posted on the FootZine web site on this page:
http://www.footzine.com/FZ_C.htm

We often hear how we should put ourselves in our patients’ shoes.  But how about taking a seat in their chair?  A rewarding and potentially eye-opening experience can be realized by sitting in your reception area with a critical eye and notebook in hand.  Take this glimpse from different chairs to allow an opportunity to see every perspective through your patients’ eyes.  Have each staff member and doctor do this over a one-month period, taking notes about their observations and suggestions for changes and improvements.  Then have an office meeting dedicated to this subject with action plans to help implement the changes.  Repeat the process one more time to access the changes; this may lead to additional things that need to be changed.

To further fine-tune this process, create a simple form with a short statement on the top which reads:

"The needs and comfort of our patients are a priority in our practice.  With this in mind, we would like to hear how you feel our reception area can be improved.  Please share your ideas below.  Attached is a small token of our appreciation for your efforts."

Attach this form to a clipboard with numbers one through ten on an 8 1/2" x 11” piece of paper.  On the bottom note that “additional comments can be written on the back of this page”.  Over the one-month period of this process, hand these forms randomly to patients.  The small token of your appreciation can be a $1.00 scratch off lottery ticket attached to the clipboard.

We would appreciate any interesting ideas from this process be shared with the FootZine readers.

Previous "Gems" can be found on their own pages of the FootZine.com web site, at
http://www.footzine.com/FZ_90.htm


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"It is a great art to saunter."  -  Henry David Thoreau, 1841

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This Sunday (or Saturday night) is when we set our clocks one hour ahead for Daylight Savings Time.  For all the talk about "losing" an hour of sleep, I love gaining the extra daylight after work, with the increased opportunity to saunter, to stroll, or even for a no-nonsense brisk walk.  Or maybe even to send and receive a few more emails.

 ~ Gayle

Copyright 2004 Gayle S. Johnson.  All Rights Reserved.
DISCLAIMER: Acceptance and publication of any letter, article, news item or advertisement does not necessarily constitute or imply approval or endorsement by myself of the product, idea, or content therein. I reserve the right to edit or to not publish any material received. Any letters published are the property of FootZine. Any health- or legal- and financial- related information is for educational purposes only and should not be construed as medical, legal or financial advice, or a substitute for the advice of a healthcare professional, attorney, financial advisor or any other consultant or professional. Information pertaining to legal matters should not perceived as legal advice, nor should discussion about such issues as Medicare, coding, and billing be considered as definitive. All content is presented as being only the opinions of the contributors and is for educational purposes only.

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