I agree on the above strategies for a start. One important point is that the coding is being done correctly so she can be possibly better paid while seeing few patients. Most doctors don't use 99214 enough. The AAFP has a great score card on their website to quickly see if you note is meeting that criteria. Most do level 4 work but code it down for fear that it 'isn't enough'. Next, reduce the number of patients per day. Maybe 16 would be plenty. Then, start getting every note done in the room with a longer visit. Remember, adequate 'time' with a patient will qualify a level 4. She should be able to go home soon after the last patient leaves. When speed on the charting increased, then number of patients can increase. A pile of charts at the end of the day is enough to burn anyone out. An MA who can do the subjective would help, but also an MA may be able to 'transcribe' the whole note in the room. The doctor could even verbally dictate the exam in the room for typing: i.e. chest clear, heart regular, no murmurs. Just some ideas I have seen done before.
