Practice Management Q&As

October 7, 2005

Addressing a chronic problem during a routine exam

Q. How should I code for a visit during which I do a routine adult preventive exam and also address a chronic problem such as hypertension or diabetes?

A. For the exam, use the appropriate preventive medicine services code (99385 to 99387 for new patients; 99395 to 99397 for established ones). If your treatment of the chronic problem requires significant additional work, report it with the proper E&M code (99201 to 99205 for new patients; 99211 to 99215 for established ones) along with modifier –25 to indicate a service separate from the exam.

Q. After I've diagnosed a patient's musculoskeletal complaint, I leave the exam room while he watches a 30-minute instructional video I've created. The video shows me explaining how to cope with his problem and demonstrating some exercises he can do at home. At the conclusion of the video, I return to the exam room for five to 10 minutes of follow-up with the patient. Does playing the video count as face-to-face counseling time that would enable me to bill a level 4 visit?

A. No, you can't count the video as a portion of the visit. Bill only for true face-to-face counseling.

Time to rethink this buyout agreement

Q. According to our small group practice's buy-sell agreement, part of the payout upon termination is return of capital invested. How does the practice provide for the payout without hurting the remaining doctors?

A. If a buyout is properly structured, they won't be hurt. In a group practice of three doctors, for example, after one leaves with his payout, each of the two remaining partners now owns half the practice, rather than one-third. So, in effect, the remaining doctors have paid out some money in exchange for owning a larger share of the business.

Your group, however, has a major flaw in its buyout methodology. Returning a partner's initial investment is not a valid way to calculate payout when he leaves the practice. For instance, suppose a group's partners each invest $30,000 for equipment. Over the years as the equipment's value depreciates, each doctor's initial investment decreases in value, too. So by the time a partner withdraws from the practice, the $30,000 figure has no meaning as the basis for determining payout.

You need to draw up a new agreement. A healthcare consultant can suggest an appropriate valuation methodology.

To keep your practice on an even keel financially, anticipate upcoming buyouts and recruit new doctors to buy in, replacing the partners who are leaving.

Medicare fees: the "handheld" version

Q. Where can I get a printed version of the 2006 Medicare Physician Fee Schedule? I prefer a paper copy to the CD-ROM version I received last year.

A. In November, your local Medicare carrier will again send you a CD-ROM version of the Medicare Physician Fee Schedule. The package should contain information on how to request a printed version. Or you can call the carrier's provider service number.

Getting test results to patients

Q. I recall hearing about a service that provides a phone number for patients to call to receive a prerecorded message from their doctor about their test results. Can you give me any more information?