Chris, I haven't had a chance to look over your sites. I will soon.
@Dan,
Thanks for the well written and very studious, detailed information on coding. I don't know if I have ever seen it done that well.
Unfortunately for me, I find E & M coding a necessary evil and find it impossible to document all my visits not only thoroughly but in a way where I can put the bullets in all the right places. I do think that a poorly documented note can lead to poor care or even lessen the chance of a good defense if sued. But, I don't think the abundance of a lack thereof should affect how I am paid. Once again, medicine does things differently than nearly every other profession. An attorney will charge you the same price for an hour's worth of work and a golf pro will always charge you $75.00 for that same 45 minute lesson whether he/she is teaching you the driver or the putter. I am sure there are many other examples of professionals charging a certain fee for a certain amount of time.
I saw 32 patients today, partly because I must see volume to make a profit and partly because most of them needed to be seen. My 3:00 patient which ended up being seen at 3:30 pm. This particular patient presented with wheezing, decreased air movement in the LLL and a left acute otitis media. Sats were 86%. After three Xopenex 1.25 mg nebs and 60 mg of Prednisone, they were up to 93%. His RR was down, his pulse rate was down and fever down from 103 to 99.9 with Tylenol and Motrin. His CXR did show a lobar pneumonia, and he was diagnosed with pneumonia, asthma exacerbation and otitis media. Given the amount of time the patient required, my note was not as thorough as it could have been. It was difficult to not charge a 99214, but technically it wouldn't meet the E & M coding requirements. On the other hand, I am sure I could turn a conjunctivitis into a 99214 if I tried hard enough. Maybe it is the only way to do it, but I just find myself throwing my hands up in the air and charging 99213s 80% of the time, if not more.
As a side note, our ED simply dictates all ten review of systems were normal.
