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    Learn how to optimize office billing and documentation

    Unfortunately, there are few among us who were correctly taught in medical school or residency to code office visits. Although there are only a handful of studies looking at how well physicians code for office visits, all conclude that physicians undercode their established patient office visits.6-9

    The most recent study examined the notes from 351 senior resident family physicians in 2 programs in Tennessee. Expert coders found that 33% of visits were undercoded based on the documentation, 50% were undercoded based on the medical decision making, and 80% of the visits were undercoded based on the number of presenting problems.10

    It is very important that we accurately code level-4 visits for established patients (ie, 99214 visits). In my experience, insurance companies pay $50 to $60 more for a 99214 compared to a 99213 visit.

    Once you understand the basics, little effort is required to correctly code and document a 99214 visit and pass the inevitable insurance company audit of your patient charts. The financial implications of correct coding to a pediatric practice are substantial, because undercoding can deny a practice tens of thousands of dollars of lost revenue every year.

    http://EMUniversity.com/ provides online video tutorials for physicians that teach the elements of correctly coding an office visit and what parts of the office note are necessary to properly document a visit.

    By following their recommendations, most office visits for otitis media, pneumonia, bronchiolitis, and attention-deficit/hyperactivity disorder will have documentation to justify billing as a 99214 visit. Enrollment in the Web site costs just $179 per year, with volume discounts available.

    In addition to the excellent video tutorials, users can access discussion forums to ask questions, which are answered promptly, and can also access a full library of case examples.

    Washable keyboards and mice

    In 2009's new products article, I presented a discussion of sanitizable keyboards, indicating that computer keyboards are a significant source of bacteria responsible for nosocomial infections.

    Computer-input devices and mobile devices are an underrecognized source of contagion not only in hospitals and medical offices but also in homes, schools, and day cares.

    One study demonstrated that staphylococci, gram-negative rods, enterococci, bacillus species, and others could be cultured from more than 50% of keyboards in medical environments.11

    Another study demonstrated that 94% of cell phones used by health care workers (HCWs) were contaminated with bacteria. In this study, 52% of surface cultures from cell phones grew Staphylococcus aureus, with more than a third of these methicillin resistant.12

    Seal Shield of Jacksonville, Florida, is a company dedicated to improving this situation. The company manufactures a wide variety of computer mice and keyboards that are built with integrated silver compounds that inhibit the growth of viruses, bacteria, and fungi.

    Additionally, these devices are spill proof, fully sanitizable with a variety of disinfectant solutions, and fully submersible and can even be cleaned in a dishwasher.

    Seal Shield's Web site features a wide variety of wireless and wired keyboards, mice, and input accessories, including mouse pads.

    Many of the keyboards feature integrated track pads as well as lighted keys. All are very affordable, with many selling for well below $100. Seal Shield also produces sleeves for the iPhone and the iPad that render them fully waterproof as well as fully sanitizable.

    The company backs all its products up with a limited lifetime warranty. Check out the Web site for a full list of products. It would also be a good idea to recommend these input devices to your patients' parents as a way to reduce spread of infections in households.

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...


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