Hi everyone and welcome to another episode of BTK. It's super excited to have this edition.

We're going to talk a little bit about something that we have not done in a while and that is talking about coding and billing a little bit of tips and tricks for you here and we're super pleased to have Dr. Sarah Vogler who's actually another colorectal surgeon, but she's also the associate chief of staff at Cleveland Clinic Florida region and she's got her MBA and has a very good acumen about these things and helped us a ton here at the clinic and we're super excited to have her on. So Sarah welcome to behind the knife. Yeah, thanks for having me. So let's just kick it off right now.

So we have a lot of trainees that are listening to the podcast and one of the common questions we get is, you know, I'm a resident, you know, they, they ask us to do a lot of different things. We got work hours, we got this, we got that and how and maybe why even do I learn coding and billing and and I would ask you, why don't we teach this a little bit more formally in residency?

Sure. So it's just one more thing to learn, right? And I remember going to residency. I don't know about you, but I kind of pretended it didn't exist. I kind of knew my attending was doing it, but I didn't learn much about it at the time.

And I think that's actually how a lot of residents go through residency, just trying to learn the important stuff. So it's going to come back at some point. You have to learn the coding and billing when you get out there in the practice.

And the best way to start being exposed to it is to ask your attendees as you're in clinic, probably more specifically, what are you doing is, you know, don't walk out of the room and just stop watching them ask them how they're doing the coding and what is even involved in the coding for people now who are realizing that this is important.

Well, number one, can you give us some examples of why it's important and yeah, some examples of why it's important as well as where should we start once we made the decision, okay, it's important. I needed to learn this stuff. What's a good way to kind of get started with the stuff.

So you get to do all these fun things all day, but unfortunately none of it happens actually really happened until you document it and then the documentation leads to what the coding and billing, you know, providers are going to say here is what you did today.

So you want to learn how to do some very good documentation and that will help guide your coding and billing. So even if you have coders and billers, that's what they're going to look at and then you can look to those people to teach you why they're choosing specific codes. I think let's try the first place to start or the professionals.

So on that, I've tried, you know, I'm somebody who amount of practice and I try to be good about, you know, my documentation, but do you have any good resources because it's all really hearsay, you know, people say, oh, you have to code, you know, this many review systems or you have to make sure you include this if you want to get your this level or whatever, but a lot of that's, it's a mystery to a lot of us.

And do you have any good resources? Are you go to your coders? Like, how did you do it? Where did you start?

So that's how I started. I started to meet with my coders monthly when I first got out of residency and they would show me what they were coding and then it was a back and forth as far as me asking, well, why did you code this or why did you code that or why didn't I get credit for this and that's really how I learned.

And once you kind of get the basics down, you can learn some of it on your own, just from different, you know, webinars and reading.

So let's jump into a little bit more specifics and, you know, I know that, you know, as Jay said, for a lot of people out there, they're like, well, you know, I got epic, it codes for me or some of whatever their EMR is, I'm just going to kind of click whatever boxes or

I got a coder and villain, I'm not going to really change anything anywhere. And then there's outpatient and inpatient, we're, you know, surgeons and then you got an op note and modifiers and anything, but let's, let's just kind of just start pretty basic. So what are the levels of visitor encounters and is there a feel or a couple of tips that you can say, you know, should a should a physician ever code a one or a two.

I mean, is it three, I've seen people who they their whole lives, they code a level three for everything, because then they're like, I'm not overcoding on not undercoding, but one of the other question I want to ask you, can you undercode, can you get in trouble for that as well. So let's talk a little bit about the levels and the types of inams and a new patient versus a

versus somebody who is a consult versus somebody else who is a follow up.

So there's ambulatory coding and then there's inpatient coding and then there's surgical coding, but so the ambulatory coding is probably the one that almost all physicians have to deal with, and that's the people you see an outpatient and there are different levels to that one through five.

When they change the outpatient coding in 2021, they actually eliminated level one from a position option. So that's more than nursing visit. So you get to take two to five.

The lower the number, the less the complex. So if you see a really complicated patient with lots of medical problems and you're cooking them for a high morbidity procedure surgery, then that's going to be closer on level five spectrum.

Whereas if you see somebody with a very straightforward problem, it's an in and out visit, not a whole lot of discussion. There are otherwise healthy. That's going to be more in the level two to three.

So that's kind of your baseline, and then you start to begin to the details of the visit and how much time do you put into the visit, how many different things do you look at?

...