Time spent on EHR data entry instead of interacting with patients is a common complaint from doctors
Martin Pricco, MD, MBA, an internist and president of Gould Medical Group in Modesto, Calif., did an evaluation with Paul DeChant, MD, MBA, deputy chief health officer of Simpler/IBM Watson Health, examining how Gould’s 360 physicians and allied health practitioners were spending their time in the EHR.  The goal was to help the physicians become more efficient and reduce their frustration with the system. Their recommendations included:

Improve the password process. Physicians should not spend any time typing passwords into workstations in the practice. Instead, provide a proximity password device or other technology solution that does not require the physician to enter a password on a keyboard each time they enter a new room.

Create a review process. Physicians often waste too much time reviewing or approving items that could have been handled by someone else with a lower licensure level. Create a system where all “in basket” items are reviewed by a member of the staff before they are sent to a physician. Items that don’t require physician input can be rerouted to the appropriate person.

Install a printer in each exam room. If physicians are spending time walking back and forth to get printouts from the EHR, consider installing a printer in each exam room. The cost of a printer is far less than the doctor’s time.

[To read the rest of their advice, visit 



Artificial intelligence (AI) and machine learning were hot topics at HIMSS. Software companies are now harnessing computing power to analyze usage patterns within an EHR, comparing that to occurrences of medical errors or a physician leaving the company, and developing a set of triggers that can warn when a physician is showing signs of burnout so an intervention or additional training can be provided.
The same is true of diagnostic tools, where AI is being used to identify patterns to help doctors find the right diagnosis and sort through meaningless data to find the information they need.
Every AI expert emphasized that the software cannot replace a real doctor, and that these are just powerful tools at a physician’s disposal to improve care and save time.

Patients: The forgotten piece of the healthcare puzzle


Another common theme from this year’s conference was empowering the patient and giving them a seat at the healthcare table. Companies are providing solutions that give patients more access to their health data and more ways to communicate with their providers.
Kristina Sheridan, a patient advocate, emphasized that patients should be an equal member of their own care team and that technology developers needed to remember that these are people behind the data points.


With physicians and hospitals looking to reduce no-shows and increase revenue, several companies have developed technologies that allow patients to virtually check-in for care and move appointments as necessary, reducing the amount of time spent in waiting rooms. For one chain of urgent care centers, wait times were reduced from three hours to 30 minutes and the reduction in no-shows paid for the system.
As patients take control of more of their healthcare, they also expect a better patient experience, and reducing wait times is a way to improve patient satisfaction scores.



After a year of running his own practice, it became clear to Brett Swenson, MD, a primary care physician, that a traditional outpatient setting wasn’t for him.
He was seeing 25 patients per day, each for 15 minutes, and half of his time was dedicated to documenting, said Swenson. “
I wasn’t getting to know patients like [I wanted to]…my practice continued to grow and it was successful based on the definition of a traditional primary-care practice, but it had become factory medicine,” he said.
Once he left behind factory medicine for a concierge practice, he needed to adopt tech solutions that would help him adjust to a patient-focused practice, especially when it came to communication.
Chatbot is a computer program that simulates conversation with human users, primarily utilizing the internet, he said. The goal of chatbots was to meet patient needs for responsiveness, communication, and better outcomes.
Swenson’s concierge practice, Swenson Premier Care in Scottsdale, Ariz., rolled out the chatbot technology in three phases. The first phase was patient-initiated communication, in which they used the technology to schedule appointments and get medication refills. Instead of calling the clinic, patients could securely text through the chatbot system and make those arrangements.
Phase two involved the clinic initiating communication with the patient. The clinic focused on patients receiving preventive care, such as a flu vaccine. In this phase, the tech was still not integrated into the EHR and the process of finding patients eligible for the vaccine had to be done manually.
The final phase, which started in February, aims to solve that problem, as Swenson’s practice recently rolled out the chatbot with EHR integration. That means every appointment made through the technology now goes directly into the EHR’s practice management suite.
[To read the rest of their advice, visit 



New research is outstripping a physician’s ability to keep up with the latest medical knowledge. Kurt Hegmann, director of the Rocky Mountain Center for Occupational and Environment Health, University of Utah, said that physicians would have to read 46 controlled trial studies a day to keep pace with current research and medical best practices.
The proposed answer is clinical support tools that can illustrate the most common treatments for a given diagnosis, thereby bringing more consistency to medical treatment while still giving doctors the ability to vary the treatment,
if required.



Information from our partner publication, Physicians Pratice, was also used in this article.

Articles

This year’s Healthcare Information and Management Systems Society (HIMSS) Annual Conference tackled major issues in medicine. Our editorial team was on-site in Las Vegas for this year’s gathering and compiled the following highlights:

Health IT: Technology innovations for your practice

Although there’s no cure for osteoarthritis, it’s certainly possible for primary care physicians to not only help their patients manage symptoms, but also improve reimbursement for doing so.
The debilitating chronic condition affects more than 30 million adults in the United States, according to the CDC. Functional and pain assessments-something many physicians perform regularly-are critical because they help target interventions that ultimately improve patients’ quality of life.

These assessments can also boost payments under the Merit-based Incentive Payment System (MIPS), one of two participation tracks under the federal law that seek to reform Medicare payments while improving outcomes and reducing costs. 

To satisfy MIPS criteria, physicians must report CPT code 1006F (indicating that they performed an assessment for function and pain) along with one of the following osteoarthritis diagnosis codes:

M15.-Polyosteoarthritis
M16.-Osteoarthritis of hip
M17.-Osteoarthritis of knee
M18.-Osteoarthritis of first carpometacarpal joint
M19.-Other and unspecified osteoarthritis

Physicians aren’t required to use validated assessment instruments to get credit under MIPS. The only requirement is that the instrument assess pain and various functional elements including a patient’s ability to perform activities of daily living. For example, physicians can use a standardized scale or ask patients to complete a questionnaire such as Short Form-36 or American Academy of Orthopaedic Surgeons Hip and Knee Questionnaire. Acceptable pain assessments include the following:

Patient-Reported Outcomes Measurement Information System (PROMIS)

Acceptable functional assessments include the following:

General quality of life: Veterans RAND 12, PROMIS (PROMIS 10 or PROMIS Computerized Adaptive Test), or EuroQol-5D

Foot and ankle: Foot and Ankle Ability Measure or Foot and Ankle Disability Index

Knee (anterior cruciate ligament): International Knee Documentation Committee Subjective Knee Form or Marx Activity Rating Scale

Knee (osteoarthritis): Knee Injury and Osteoarthritis Outcome Score (KOOS) or KOOS Jr.

Hip (osteoarthritis): Hip Disability and Osteoarthritis Outcomes Survey (HOOS) or HOOS Jr.

Shoulder: American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Oxford Shoulder Score, or Single Assessment Numeric Evaluation

Shoulder (instability): ASES or Western Ontario Shoulder Instability Index

Elbow, wrist, and hand: Disabilities of the Arm, Shoulder, and Hand Score (DASH) or Quick-DASH

Osteoarthritis functional and pain assessments help meet the overarching goal of MIPS to improve outcomes and reduce costs because these assessments help to identify patients who can benefit from early intervention, says James Daniels, MD, MPH, a primary care physician in Quincy, Ill. Daniels served on the American Academy of Orthopaedic Surgeons committee that helped develop the osteoarthritis MIPS measure.
“We’ve got an aging population. This means the volume of patients with osteoarthritis is rapidly expanding,” says Daniels, who is also professor of family medicine and orthopedic surgery at Southern Illinois School of Medicine in Carbondale, Ill. Osteoarthritis assessments can help physicians intervene and potentially improve long-term outcomes, reduce hospitalizations due to falls, and prevent expensive surgeries such as hip or knee replacements.

In many cases, functional and pain assessments paint a more accurate picture of a patient’s experience than a diagnostic image, says Fotios Koumpouras, MD, a rheumatologist and assistant professor of medicine at Yale University in New Haven, Conn. Koumpouras often sees cases in which an X-ray reveals minor disease, but the patient reports significant pain or loss of function that requires intervention.
However, physicians also need to be aware of the potential for inflated pain scores due to the presence of comorbid conditions, says Koumpouras. “We know by studies that individuals with depression, for example, will score worse on the pain assessments not necessarily due to their primary disease but because of comorbid conditions that affect their answers and perception of what’s going on,” he says. In these cases, physicians may need to address the underlying depression in order to improve osteoarthritis symptoms.

Still, the assessments are a good first step to get patients on the right course of treatment, says Nitin Damle, MD, an internist at South County Internal Medicine in Wakefield, R.I., and past president of the American College of Physicians. Half of his patients over age 50 have some degree of osteoarthritis. “[The assessments] give us a better idea of how to manage the osteoarthritis with anti-inflammatories, physical therapy,
weight reduction, stretching, tai chi, balance exercises, or a combination of all of these,” he says.

Aside from helping physicians meet the relevant MIPS measure, osteoarthritis functional and pain assessments can help justify to payers why patients may need physical therapy, says Daniels. The information also helps orthopedists to whom patients are referred. “The orthopedists don’t need to start from scratch, which probably saves a visit or two in terms of trying different methods,” he adds.
Finding the time for patients to complete these assessments-and then incorporating that information into the EHR-is a challenge, says Koumpouras. Some EHR vendors may be able to load the assessments so physicians can send them to patients via the portal for completion prior to their appointments.

Asking patients to come into the office in advance of their scheduled appointment time to complete the forms using the digital pen or completing the forms on paper and scanning them into the EHR may also be an option.

Carl Franzetti, DO, a primary care physician at Riverdale Family Practice in New York City, hopes to use his EHR kiosk to help perform the assessments. Between 70 and 80 percent of his patients over the age of 30 have some form of osteoarthritis. “Ideally, we want the patient to come in and go right to the kiosk to answer a series of questions that populates in the chart right away,” he adds. Patients already use the kiosk to answer questions related to activities of daily living, fall screenings, and depression screenings.

The goal is to have as much information as possible in the EHR prior to the physician stepping into the exam room so he or she can spend time recommending treatment rather than collecting information, says Daniels. “If you’ve done the history and physical-and you’ve got the imaging,” he says, “but you don’t have these other forms, you’re going to be making decisions without having the whole picture.”


Although there’s no cure for osteoarthritis, physicians can help patients manage this chronic condition to reduce overall costs. Doing so not only improves patients’ quality of life, but it can also boost physician payments under Medicare payment reform and in risk-adjusted payment models.

Anissa Calhoun, COC, CPC, CDEO, coding specialist in Boston, Mass., says physicians should document following details for osteoarthritis:
1. Type of osteoarthritis (i.e., polyosteoarthritis, primary, post-traumatic, or secondary).
2. Affected joints (i.e., hip, knee, first carpometacarpal joint, shoulder, elbow, wrist, hand, ankle, or foot).
3. Laterality (i.e., left, right, bilateral, or unilateral).

Generally speaking, payers are looking for specificity at all times, says Calhoun, adding that many physicians continue to document “osteoarthritis” without any additional information. “We had that grace period after ICD-10 went into effect when insurance companies were flexible with unspecified codes,” she says. “But now that time is over, and insurers are starting to require more information.”

Although there’s no cure for osteoarthritis, it’s certainly possible for primary care physicians to not only help their patients manage symptoms, but also improve reimbursement for doing so.

Boost MIPS scores while improving osteoarthritis patient management

Approximately 1.5 million people in the United States have rheumatoid arthritis, according to the Arthritis Foundation. Prescribing a disease-modifying anti-rheumatic drug (DMARD) for patients with rheumatoid arthritis not only helps alleviate symptoms, but it may also help physicians trigger performance-based bonuses from certain commercial payers.
That’s because rheumatoid arthritis is a condition included in the 2018 Healthcare Effectiveness Data and Information Set (HEDIS), a tool used by more than 90 percent of commercial insurers to measure physicians’ performance on care and service.
Many payers tie physician bonuses directly to their ability to satisfy HEDIS requirements-in this case, the ability to dispense at least one ambulatory prescription for a disease-modifying anti-rheumatic drug for patients with rheumatic arthritis ages 18 and older



Early intervention is critical for patients with rheumatoid arthritis, and it’s also something that payers increasingly must report as a HEDIS measure. If physicians can show that they provide high-quality, evidence-based care-either through prescribing DMARDs or working with rheumatologists to co-manage care-payers might provide physicians with a performance bonus, says Colleen Gianatasio CPC, CRC, risk adjustment quality and education program manager at Capital District Physician’s Health Plan in Albany, N.Y.
Physicians-particularly those in rural areas without easy access to rheumatologists-need to feel comfortable recognizing the signs and symptoms so they can prescribe first-line standard medications, such as methotrexate, says Fotios Koumpouras, MD, a rheumatologist and assistant professor of medicine at Yale University. 
“The first thing is to pick up the phone and call the rheumatologist,” he says. “A quick phone call can actually make the internist feel more comfortable to initiate a treatment plan.”
Nitin Damle, MD, an internist in Wakefield, R.I., agrees. “The more we can communicate with rheumatologists, the better we can be at managing the problems that arise,” he says. “If we need to change a medication, for example, that’s much easier to do when there’s a collegial relationship.”
Having a collegial relationship with rheumatologists not only helps physicians meet MIPS and HEDIS measures, it can also assist with Accountable Care Organization (ACO) quality reporting, says Gregory Steinmetz, MD, a primary care physician at Associates Primary Care Medicine in Warwick, R.I.
For example, to fulfill its obligations under an ACO contract, Steinmetz’s practice previously had to report whether patients with rheumatoid arthritis were prescribed a DMARD. Insurers sent the practice lists of patients diagnosed with rheumatoid arthritis, and someone from the practice had to call each patient’s rheumatologist to obtain documentation confirming DMARD treatment. Creating a relationship that promotes the ongoing exchange of information can help practices meet this quality metric more easily, he says.
Chronic care management (CCM) programs can help open the lines of communication with rheumatologists to obtain this information, says Gianatasio. That’s because with CCM, practices have already created workflows that promote frequent communication with specialists who help co-manage chronic conditions, including arthritis. “We really encourage communications between our primary care physicians and specialists,” she says. “We still see a major gap between them. At least once a year, you really should be asking for charts from the specialist.”

Prescribing a disease-modifying anti-rheumatic drug (DMARD) for patients with rheumatoid arthritis not only helps alleviate symptoms, but it may also help physicians trigger performance-based bonuses from certain commercial payers.

Manage rheumatoid arthritis and related quality metrics

For physicians trained to address the ills of the body and mind first, discussing costs of care with patients may feel outside their typical role. Thus, physicians may put off these conversations because they are unsure how to handle them.
However, patients are increasingly interested in knowing what they will pay in advance. The price of health insurance premiums has increased by 55 percent in the past decade, according to a 2017 Kaiser Family Foundation report. As a result, patients are facing greater out-of-pocket expenses and more high-deductible health plans. This requires physicians to conduct more conversations about costs of care with patients.
Fortunately, several organizations have begun to develop scripts and approaches for physicians to tackle these conversations with greater confidence. That is important, as not discussing costs of care can have a negative impact on patients’ likelihood of getting necessary treatments or medications, according to a 2016 study published in Health Affairs.
“There’s this ivory tower [notion] in medical school that money doesn’t matter; just do what’s right for the patient,” explains Dustyn Williams, MD, a hospitalist and internal medicine clerkship director at Baton Rouge General in Baton Rouge, La. While he agrees that “doing what’s right” for the patient’s care is most physicians’ goal, “the reality is that healthcare costs are really high. And physicians don’t have that education until they get into practice.”
Indeed, in a 2016 study by the Society for Medical Decision Making (SMDM), physicians only discussed medical costs with patients about 30 percent of the time; and of those discussions, only about 40 percent included conversations in which physicians and patients sought alternatives that would save costs on medications or tests.
The study also found that 59 percent to 80 percent of patients want to discuss out-of-pocket costs during their visits with physicians, and 91 percent of physicians believe that managing patient costs is important.
Emmy Ganos, Ph.D., program officer at the Robert Wood Johnson Foundation (RWJF), says the foundation was inspired to take action after reviewing the SMDM study results. “Typically those conversations [about costs of care] were short, some as little as a minute, but when done well, they resulted in changes that were really important to care plans or advice for how to find a drug less expensively,” she says.
The study suggests four strategies physicians can bring up with patients to help lower costs without changing the care plan:

changing logistics of care, i.e. the timing, source, or location;

In addition, the study recommends four strategies for reducing costs by changing the care plan:

switching to lower-cost alternative treatment or test;

switching from brand name to generic medications;

and stopping/withholding interventions for a time to allow a patient to save up.

Ganos says that these strategies can provide physicians a roadmap to help patients reduce their costs.
The RWJF has partnered with Avalere Health, a Washington, D.C.-based healthcare consulting firm, on a research project called “Key Steps to Improve Patient-Clinician Cost-of-Care Conversations.” The foundation also funded eight research studies to help physicians and care teams improve these conversations and hopes to publish their results later this year or early in 2019, Ganos says.
“We feel it’s important to have these conversations while a patient is receiving care/making decisions about care,” Ganos says. This is because sometimes a cost conversation may involve switching a care approach or medication “and that should be made with providers.”
One reason physicians may avoid cost conversations is a lack of transparency about costs to patients from payers, according to Williams. This forces practices and patients to go through lengthy pre-approvals, he says.
There have been efforts to legislate greater transparency-and price transparency tools exist, such as apps and even programs that can be integrated into an EHR-but there’s a long way to go until full transparency has been achieved.



To help doctors and patients, several healthcare organizations, including the American College of Physicians (ACP), are working to standardize these cost-of-care conversations, even providing sample scripts to empower both physicians and patients.
Cynthia D. Smith, MD, vice president of clinical programs at the ACP, points out that providing a script also helps physicians avoid any implicit bias they may have about which patients are likely to need financial assistance.
“You have to be careful to not make assumptions about people,” Smith says. “You can’t really assume that one patient might have a problem paying for care; you have to ask.”
The ACP has developed a “high value care initiative” that walks physicians through a patient encounter with specific guidelines that include addressing cost-of-care issues. One step is to screen for “logistical and financial barriers to care” with questions such as:

Are you worried about how your care will be paid for?

If so, how can we help you with these problems?

Do you have difficulty getting to appointments or medical tests?

The last question is of great importance to Ganos and colleagues at the RWJF because they’ve found that social determinants of health also play a big role in patients getting treatment. Those kinds of costs are a big unmet need,” Ganos says.
In addition to guiding physicians on how to be sensitive to patients’ financial needs, Wendy K. Nickel, MPH, director of the Centers for Quality and Patient Partnership in Healthcare at the ACP, points out that standardizing the process leads to greater shared decision-making between physician and patient. A standardized script can enable physicians to become better educated on the costs of treatments, procedures and medications.
Ganos points out these conversations don’t always have to be solely up to the physician, but should happen within care teams.
She’s seen the importance of engaging other staff members, such as receptionists, who field a lot of cost-related questions, or nurse practitioners and medical assistants. Ganos encourages physicians to work with their staff to put together a list of answers to frequently asked questions in advance of patient visits.
It might also be helpful for physicians who are engaging in a greater number of conversations about cost of care to remember that patients have more cost sensitivity than they used to, says Nickel. “What they’re really interested in is not what the charges for giving certain tests or treatments are, but what they’re going to have to pay out of pocket.” That, she says, is “a very complicated answer to come up with.”



Linda Girgis, MD, a primary care physician in South River, N.J., makes a point of helping her patients find out the costs of tests and medications she prescribes to ensure that they follow through on their treatments.
“The way I look at it, if a patient needs a test, they need a test,” Girgis says. “My medical advice is not going to change, but it’s not helpful to them if they can’t pay to get it.”
She explains to them that they have the right to know price information up front before they get a test or a treatment. “I tell them to shop around, to ask for prices and be sure they know their coverage.” She says her patients feel better knowing she is advocating for them.
Girgis recommends physicians take the time to find some key resources to help patients and have those accessible during visits. She suggests keeping phone numbers on hand, such as those for the local facilities that perform certain tests, as well as those of social workers who can help patients find financial assistance.
Williams sees more pressure on physicians to add more tests and treatments, refer out, and even get unnecessary testing. He hopes physicians can push back against this pressure particularly when a patient is concerned about being able to afford their treatments or medications.
He encourages physicians to prescribe generic medications whenever possible. Though, he acknowledges, this can be difficult for physicians who are getting pressure from pharmaceutical reps and even their own medical systems to prescribe brand- name drugs. He takes the approach that the patient and the physician are a team and physicians should try to be a patient’s advocate at all times.
If a patient is resisting a medication or treatment the physician has prescribed due to fear of its cost, he urges physicians to be sensitive to the patient’s financial status. “Having those conversations isn’t about questioning the physician’s decision, it’s about questioning this gargantuan broken system that both the physician and patient have to work within.” The goal is to get the patient the best treatment option they can afford.
If cost-of-care conversations feel awkward, Ganos hopes physicians will use scripts and encounter models such as those created by the RWJF and the ACP until it becomes second nature.



Equally important to ensuring open communication around costs of care is empowering patients to ask the right questions, says Ganos.
She directs patients to a document published by the non-profit Consumer Health Choices, on five questions patients should ask their doctor before a test, procedure, or treatment. The questions are:

Nickel urges physicians to remind their patients to familiarize themselves with the mechanisms of their health insurance plans. “If you have a high-deductible health plan, what are the implications if you paid off your deductible late in the calendar year and then require some sort of expensive treatment? Although it might be covered in December, if you wait until January of the next year, you will have to pay out of pocket. It’s important to know those kinds of things,” Nickel says.
Websites such as Healthcare Bluebook allow patients to plug in the cost of specific insurance premiums and compare them to other premiums online. Apps such as GoodRx and Amino offer some price comparisons for some treatments and procedures, but not all.
However, Ganos says that it’s a lot to ask of patients to use these tools on their own.
“Patients making decisions in the absence of a provider may prove to be less than helpful to their care,” she says.

Financial discussions with patients don’t have to be uncomfortable for physicians

Navigating cost-of-care conversations with patients



Marginal tax rates determine how much you will pay in taxes according to your taxable income. Your taxable income determines your tax bracket, which is based on the highest tax paid, which is your marginal tax rate, or the rate that one pays on the next dollar of income. Keep in mind not all income is paid at the highest rate.
The tax rates for 2018 have changed, slightly leaning on a 3 percent reduction overall compared to 2017 for all brackets.
What you will need to consider during 2018 is if and how to move your taxable income into a lower bracket to save on taxes. Guidelines have changed if you are a physician employed by a hospital or own your practice. Each entity has its own rules on what itemized deductions can be taken off its taxes. The standard deductions have doubled for everyone, but might not make up for limitations on itemized deductions.
If you think you might be able to deduct yourself into a lower tax bracket, work with an accountant and your business manager to anticipate any adjustments you can make to lessen your 2018 tax burden.



A Limited Liability Company (LLC), Personal Service Corporations, other partnership, or S corporation may choose to be taxed as a “pass-through business.” It becomes a pass-through because it doesn’t pay taxes itself as a corporation, but instead passes profits on to the owner, who pays taxes based on his or her own individual rate. Many physicians have pass-through businesses. Most small businesses organize as a pass-through entity or as a business owner who files a Schedule C.
Pass-through businesses have new rates with the 2018 Tax Code. For C corporations, there is a flat tax of 21 percent, whereas in the past the tax was a progressive 15 percent to 39 percent. For those with personal service corporations, the new rate is a flat 25 percent. Pass-through entities have ordinarily been taxed at the individual level after separately stated items are “passed through” via form K-1.
The pass-through income deduction is 20 percent of your share of W-2 wages that the business pays you up to $157,000 for single filers (who are single, married filing separately, head of household, or qualifying widow(er) with dependent child) and $315,000 for joint filers (married filing jointly). Above these thresholds and up to $415,000, the deduction is the greater of 50 percent of W-2 income or 25 percent of W-2 income plus 2.5 percent of the cost of tangible depreciable property.
Specified service corporations have a phase-out for higher income earners. In 2018, the phase out of the 20 percent deduction begins at $157,000 for single filers off their allocable share of business income.



The 2018 tax plan has many changes that can affect you and should be examined with the advice of a licensed tax professional. There are many options and potential pitfalls that can happen in adjusting your income to qualify for a lower tax bracket.
Seth Swenson, MBA, is president of Orchid Wealth Management. Send your financial questions to medec@ubm.com.

Prepare now to minimize this year's tax bill.

Understand, prepare for 2018 tax changes 

Getting paid requires accurate documentation and selecting the correct codes. In our Coding Case Studies, we
will explore the correct coding for a specifi c condition based on a hypothetical clinical scenario.

 The patient has a respiratory and sinus illness, with four days of worsening cough productive of green sputum. He has had yellow sinus drainage, sinus congestion, and sinus pressure. No fever or chills. No flu-like symptoms. He used Mucinex over the weekend. No neck pain or stiffness.



 Negative for activity change, appetite change, chills, diaphoresis, fatigue, fever, and unexpected weight change.


 Positive for congestion, rhinorrhea (yellow), sinus pain (frontal) and sinus pressure.


Negative for photophobia, pain, discharge, redness, itching, and visual disturbance.


 Positive for cough (productive of green sputum, no blood).


 Negative for chest pain, palpitations, and leg swelling.


 He is oriented to person, place, and time. No distress.


 Tympanic membrane and ear canals normal.


Mucosal edema and rhinorrhea present. Right sinus exhibits frontal sinus tenderness. Right sinus exhibits no maxillary sinus tenderness. Left sinus exhibits frontal sinus tenderness. Left sinus exhibits no maxillary sinus tenderness.


 Oropharynx is clear and moist and mucous membranes are normal.


 Conjunctivae and EOM are normal. Pupils are equal, round, and reactive to light. No scleral icterus.


 Normal range of motion and phonation normal.



Continue Mucinex DM
Zpak antibiotic as directed until all gone.

 Frontal, ethmoidal, sphenoidal, maxillary, other


J01.00 Acute maxillary sinusitis, unspecified
J01.01 Acute recurrent maxillary sinusitis
J01.10 Acute frontal sinusitis, unspecified
J01.11 Acute recurrent frontal sinusitis
J01.20 Acute ethmoidal sinusitis, unspecified
J01.21 Acute recurrent ethmoidal sinusitis
J01.30 Acute sphenoidal sinusitis, unspecified
J01.31 Acute recurrent sphenoidal sinusitis
J01.80 Other acute sinusitis
J01.81 Other acute recurrent sinusitis
J01.90 Acute sinusitis, unspecified
J01.91 Acute recurrent sinusitis, unspecified
J32.0 Chronic maxillary sinusitis
J32.1 Chronic frontal sinusitis
J32.2 Chronic ethmoidal sinusitis
J32.3 Chronic sphenoidal sinusitis
J32.8 Other chronic sinusitis
J32.9 Chronic sinusitis, unspecified
Use additional code to identify:
â exposure to environmental tobacco smoke (Z77.22)
â infectious agent (B95-B97)
â tobacco dependence (F17-F17.299)
â tobacco use (Z72.0)


J01.10 Acute frontal sinusitis, unspecified
J20.8 Acute bronchitis due to other specified
organisms
B96.89 Oth bacterial agents as the cause of diseases classd elswhere

Getting paid requires accurate documentation and selecting the correct codes. In our Coding Case Studies, we will explore the correct coding for a specific condition based on a hypothetical clinical scenario.

Vol. 95 No 08

Health IT: Technology innovations for your practice

Boost MIPS scores while improving osteoarthritis patient management

Manage rheumatoid arthritis and related quality metrics

Navigating cost-of-care conversations with patients

Understand, prepare for 2018 tax changes

Coding case study: Sinusitis