Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 159
“Getting Paid, Retrospective Audits & the Correct Use of History in Your Evaluations and Re-Evaluations”
I have previously written that I welcome you sending me copies of your initial evaluations in template form, meaning I need to see the templates, not the completed reports. You can fax them to 661-843-1062. Please make sure your name and phone number are on them. This will tell me if you are being complete in performing all of the required points for the level you are billing and if you are protecting yourself from predatory carriers who will work to have you re-pay everything you have gotten from them from the day you started practice. Do not be lulled into thinking that you have been in practice for 10 years and they can’t go back to the beginning. Fraud has no boundaries and the carriers, with the help of the courts, consider improper coding a form of utilizing your paperwork in a systematic way to defraud the carriers. This empowers them to go after you for Federal RICO, which carries treble damages, and if you consistently code improperly, you will lose.
Do not be angry at the “big bad carriers.” They are playing the game by the rules and you have been forewarned for quite some time. It’s just that the time is here and you have to be better at what you already know how to do. If you get “screwed” remember, it is you who screwed yourself. Just do it right from the beginning and there are no problems.
AS I review many of your evaluations and re-evaluations, I often notice that many of you omit past medical, family and social histories. These are MANDATORY requirements for 99203, 99204 and 99205 and 99214 and 99215. A consistent absence of these points will be enough to show a pattern of problems allowing the carriers to use the word “fraud,” as the guidelines clearly state they must be present. There are a number of other elements of history of present illness and review of systems that also need to be met in order to qualify at every level. I will be going over these in future consultations and on the new Web site, I will be posting a graph to help you understand.
If you feel that your evaluation template does not protect you by forcing you to perform all elements, either change it or go to the “Forms & Template” page of the Web site and get the one I created for you. It was a collaboration, as previously reported, of many professionals and coders to meet every E & M standard and will protect you if completed thoroughly. The 6 P’s are required.