Welcome to the world, where we help Euro staff achieve keep economic and fit. So there is defined left to focus on Pair and Happy Life. Welcome to episode 69 of the Urology Coding Reimbursement Podcast. I'm your host, Scott Painter, with my co-host Mark Painter and Dr. Ray Painter. And today we're going to revisit the question should urologists and APPs do their own coding? And uh this was a topic that we had in our monthly webinar series uh available to those that uh belong to the PRS network. And we wanted to share that with you. It has a lot of great information. Mark uh pulled out some some statistics as well as uh kind of the pros and cons. And uh we wanted to have a further discussion on this topic. So with that, I want to turn it over to Mark to share with us uh kind of his thoughts on answering that question. Should urologists and APPs do their own coding? Mark, it's all yours.

Thanks, Scott. Um so yeah, so when we start talking about learning coding for the physicians and mid-levels or the qualified health uh care professionals that are out there, um, we we we see a lot of pushback. Um and so I kind of collected over a time a few pros and cons that I've heard from different groups that are out there. So from the con side, um we hear a lot that this is a distraction from care, that ultimately physicians went to school to become physicians. They didn't really need to learn all this administrative background and why should we do it now? It's a distraction from what I really should do, which is provide care for my patients. Um, another one is uh coding changes all the time. It's hard to keep up, so it's not just a one-time investment. I gotta keep, I gotta keep on uh keeping on and learn all the changes and and keep up with all of that. Uh and then another one that we hear a lot is well, there's an upfront cost. Um, time is obviously an investment, but in in case in some cases it's money as well. Um you know, learning from buying books and going to courses, those types of things. Um, so that's something I I don't want to spend. I'll just I'll let my coders do all that. And then the last one that we hear is Ray told us to practice at the top of our license. And if I'm coding, I'm not practicing on the top at the top of my license. Um so um why should I be the one to learn coding? That's taken away from being at the top of my license. So those are some of the cons that we've heard um over the years. Um, the pros on the other side that we see, and we've heard this from um actually both physicians and from the coding staff is a physician who understands coding gives me better documentation. I have a lot easier time um showing my documentation and coding to the payers on the other side, and and my my my claims get paid. It saves me a lot of time. So that better documentation is a piece of it because there's there are a few different requirements in the documentation world than it is than the requirements that are there for just putting down the clinical record. The very important and most important part of the record, which is what are you doing clinically so you know what what you're doing to treat, or your partners can do can do that if you have partners. So better documentation was one of the pros. Another one was lower staff burden. Um, if your physicians are submitting codes and everybody's comfortable with those, now your billing and coding staff is worried about making sure that the claims fit the payer profile, that they match the LCDs, the NCDs, and you're getting paid better going forward on the front end. Um uh and it also makes it a lot easier on the back end to pull the data with medical record requests or uh pull the documentation to support the coding that's there. So across the board, um you decrease the burden on the rest of the staff uh by understanding coding and submitting that on your own. The other is consistency of process. A lot of practices we go into, there's five physicians and five different ways bills go out the door. Um if you have everyone in the practice set up so that they're all coding and doing well, they've learned coding, then uh the practice can run at least that portion of the practice uh under the same protocols and procedures. It makes life a lot easier to train people, um, a lot less susceptible to a single individual um being out ill or um or leaving the practice for greener pastures, whatever is there, that process is much easier to replace if everything is much more consistently done. And and your physicians are the pivot from which everything works. Um and then the last one was just flat-out comfort. And you know, this is something that some physicians have been comfortable with over the years in leaving in the hands of their coders and billers. Um, but um, I can tell you that being able to sleep at night knowing that your documentation is good, um, that it supports what you charged day to day, so that if you do get a request for your records, you're happy to send them. Um that's comfort um walking away from the practice. And and it and it also makes you a little more comfortable in your discussions with your payers, especially if you're in an employed situation where you're a little bit disconnected from that particular group that may um have interpreted or pushed the rules a little differently, and um, being able to go toe-to-toe with them to make sure that they understand the way things should be done and the way practice works with that foundational piece just makes that conversation go much better. It's a lot more comfortable in the overall process. So um, when I weigh this out, the the one thing I didn't put on the pro con list um was money. Um, from that standpoint, um there is without a doubt, we've seen over the years a significant advantage from a gross revenue standpoint for for those physicians that understand coding and pick the right codes and provide the the best documentation. Um they do consistently better revenue-wise, um, so anywhere from 10 to 15 percent better because of their their coding patterns and their support. Um so when we look at all of those things rolled together in the pro and con list, um the next thing you want to look at is um what if what is it that you need to focus on? Because there are valid points in the con list of not practicing at the top of your license, learning, spending too much time, all of those things um that are required. Um so uh you want to make sure that uh you you do things the right way. So I went in and I did a little bit of uh data extraction from InfoDive. Um this is a tool that I've talked about before, I really like. And right now we've got 897 urologists in the benchmark for InfoDive. Um, and um, so I pulled out some data, I looked at the average revenue for those 897 urologists, and and over the last 12 months it's been about 1.124 million as a gross number. And when I looked behind that number to see what is 80% of that revenue, you have many of you have heard me speak before. I'm a big fan of the 8020 rule. So I looked at 80%, and 80% of the revenue was represented by just 75 codes. And when I took a second look and removed the drugs and lab codes, um, the gross revenue went down to $888,000, and the 80% rule uh code count also dropped uh to uh only 62 codes. Um, so when you take a look at it that way, you know, it's kind of like you know, could you get by in a foreign country with 62 words? Um probably, um, if they were the right 62, but you'd have to figure it out. But in in billing and coding, um, from a data perspective, learning those 62 codes um would make a huge difference in your practice. And then so then I wanted to find out what what kind of work would it take to learn those 62 codes. So then I dropped down a little bit further. Um, from a revenue standpoint, 40% of the revenue was represented by 15 EM codes, seven office visit codes, two consult codes, and five hospital codes with one chronic care management code. So, as an aside, those of you who are not looking at chronic care management might want to think about it because obviously it is a uh a revenue opportunity for urology. Um, but when you think about it, the the the 14 codes in the EM section that are left over really only require that you learn two different systems right now, the 2021 system and the 2020 system. And you know, the the the 2020 and before system was something that you may have had a decent grasp on over the years with the history, physical, and medical decision making. So a little bit of time invested in learning medical decision making, which can get you a lot of a long way to both sets, um, can can cover 40% of your revenue. Um fairly uh focused learning. Um percent of the revenue uh comes from two medicine codes, uh, the injection code, um one injection code and one Doppler code, which are again fairly easy to learn the documentation support for that. Six uh radiology codes represented three percent of the revenue. That was four ultrasound codes and two CT codes, so not everybody does full CT, but again, not a lot of work to learn the documentation requirements for those. And that leaves us with 37 surgical codes for 50%, 56% of your revenue. Two of those were in the 60,000 series, um, in this case the inner stem and the PTNS. Um, and then 34 codes from urology uh from the 50,000 series, most of them uh in the CISTO section, the 5-2 uh section, and one from the um from the lymph system or the 30,000s, which is the robotic lymph adenectomy. Uh so you're really not talking about a great deal of focus um that you need to learn as far as the breadth of codes and the and the the the work in the CPT manual. So that leads me to the overall conclusion that yeah, physicians should learn coding. Um, but they don't need to learn all of it. They just need to learn what they that what they need to deal with. And um when you when you dig into the numbers, ENM is a requirement. Everybody needs to learn ENM, take the time, invest the time there to learn your ENM codes. Um, for the rest, you just need to study your data. Um, I looked at this from revenue, you can look at it from volume, you can look at a lot of different ways, but data can drive a lot of your focus and where you need to go. You you use data to treat physicians or to treat your patients across the board, uh, reading and studying and seeing what's the latest as far as that data is concerned. Use your data from your business to look at your business decisions. And this is where studying those, running those numbers, and really figuring out what you need to learn and learn well is very important. Now you do have to learn the foundational concepts of globals and modifiers. You don't necessarily need to learn the numbers or the letters for the modifiers, but understanding those modifiers and those concepts that are important to you, like modify like modifier 25 or an ENM on the same day as a minor procedure, those are important concepts that you need to be able to pull out to code appropriately and communicate with your staff. And and and that's another piece that needs to be developed in all of this is clear communication with your billing and coding staff, your front desk, your administrative people. Um they need to know uh when you know what you're doing and and when you've got it down and when you need help. And you know, with with the 80-20 rule, that still leaves 20% out that you're you might need some help on. So being able to communicate when and and what you need help with is key, and and you need to be able to do that seamlessly and and and very efficiently. And and it really leads back then into our overall topic of team. You know, having the urology practice set up in a good team environment where every player uh within the group knows what their role is and how to communicate with the others uh will increase your fish if efficiency across the board and really help you focus not only on making sure that your gross revenue or your income line is good, but your net is good. Um and you know, ultimately, if you can if you can do better from the gross and cut down the administrative cost of what you're doing, that increases the net. So use your data, look at what you need to know, um, and um and and learn those foundational concepts, um, and you will have a better functioning practice, a more efficient practice, and uh a healthier financial practice.

Mark, that was an excellent discussion. I I would like to add one thing to your pro and con column, and that is time. Now I think most physicians would uh put it in the con column that it would take more time to learn and to to do your coding. But I put it in the pro column because if you learn the basic concepts of globals and the fact that modifiers can be used to when they need to be used and the documentation needed to use them, and you work with your coding team to code all of those usual things you do uh up front so that you have it in a what we call a short a short list, then all you gotta do is check what you've done and and communicate uh what uh should be done to your coders, and their working as a team uh will help you to do one other thing, and that's be accurate with your submission. So, you know, using the shortcuts that you can use so you're not reinventing the wheel every time you do a surgery and uh and and knowing the basics of what you do, you can save yourself a lot of time and not having to answer questions later about your documentation. What did you mean by this? Was this procedure such and such? And also for claims that weren't submitted appropriately that were denied, you have to deal with the coders to help correct that. So I think it'll save you time if you actually learn the basics and apply the shortcuts you can apply. The ones we've been teaching for years in our seminars, developing a short list, also in the coding course.

Well, that data certainly supports uh the the the way you put together the course, uh the coding course, Ray, and and supports the uh you need to know what you need to know. You know, it kind of sounds cliche, but uh that is so true. And uh, you know, you need to learn what what is truly uh important to your practice. And using that data to show that is uh is critical. Save you it will save you a lot of time for sure. Um and uh speaking to that, I do want to put in uh uh uh just let you all know that this is the last week to register for the urology coding course. We have a uh urologist edition and also a coders, billers, and admins edition. Uh and the urologist edition does include APPs as well. So uh registration closes October 1st if you're listening to this uh when it's released. So we encourage you to get in, get registered, and join us because a lot of these concepts and ideas is you know that's what we've been teaching for a long time, and that's uh what Ray's put in the course. So we do encourage you to do that, join us there or uh and or join us for our seminar, the urology coding, the urology advanced coding and reimbursement seminar. We have one coming up in Las Vegas in December and one in New Orleans in January. So we uh you know again, we're teaching a lot of this uh the the same concepts here so that you learn what you need to know. So uh I will we will put that information on the episode website and that or webpage, and that is prsnetwork.com forward slash zero six nine.

One other thing I'd like to mention while we're talking about that is we haven't talked about the misconceptions and misunderstandings that occur in the system. A good example of that is a friend of mine that took the little quiz that we sent out by email. Some of you may have sent it seen it and may have taken it, but this was set up to test different concepts that every uh physician and coder should know. And he said he took it according to the way his compliance group required them to code in their big system and he got uh only six out of the ten correct. But when he took it uh under what he knew he got nine out of the ten correct. Uh this just is uh another example of many we've seen in the past. I've been asked to go into several universities in order to try to uh correct some of the misconceptions that their compliance department had. So if you don't know what should be, you don't know what is being done incorrectly. All right.

All right, well, with that we'll wrap up this episode. Um Ray, any uh any final thoughts? No, not for me. Mark, any final comment?

No, just the one to uh use your data. Um it's there, it's it can be tortured out, and it can uh it can give you a lot to look for. So use your data and and figure out what it is you need to know across the board and and and make make it productive. Use your time well.

All right. Final word to you, Ray. Happy coding. Thank you for listening to the Urology Coding and Reimbursement Podcast, where we hope Urology. And their staff maximize income and efficiencies so there's time and energy for patient care and a happy life. Special thanks to Carl Painter for the music today. You can find his music on Spotify under his record label, Feduicery.