Claimocity is Simplifying the Complex: Inpatient CPT 2023-24 Edition

“We offer world-class compliance and coding support to help inpatient doctors thrive.”

2023-2024 are keystone years for guidelines changes to critical inpatient CPT codes and the theme of the e/m updates has been a much-needed simplification.

The AMA provides a cohesive general overview of these changes but there is a lot to digest for busy physicians and they cannot afford to fall behind when so much is on the line for their accounts receivable. Some code groups were eliminated and others rolled up or combined. Inpatient and observation care were unified into a single structure. Patient history and physical exam were eliminated as contextual reasons for coding. And extended care was simplified from a hierarchy multi-code system to a single simple repeatable 99418 cpt code based on time increments. 

Yet simplification can be confusing at first as the newness and scope of change, as well as the lack of easy-to-understand resources explaining how it works in non-biller layman’s terms means that even the condensed billing explanations can be hard to decipher for the doctors that need to implement these changes in their daily rounds.

Physicians tend to build strong habits through repetition and experience, honing their techniques to a mix of art and science, and when habits are long ingrained, it can be a pain to retrain the brain to use new methods, especially with something ancillary to medicine such as CPT Billing, which is more clerical admin work than treating patients and practicing medicine.

“One of the biggest objectives of this year,” says Jim Sholeff, CEO of Claimocity, “has been expanding our array of resources to inpatient physicians of all specialties who need these tools to thrive. From workflow tweaks to fully automated billing solutions to an array of inpatient CPT cheat sheets to help doctors grab the right code at a glance.”

The term inpatient specialty has often been synonymous with the term hospitalist, which is used to specifically reference an internist or internal medicine specialist. But both hospitalist and inpatient physician terms now cover a broad array of specialties servicing the hospital and facility communities beyond internal medicine.

These include PM&R (physiatrists), critical care (intensivists), emergency medicine doctors, inpatient psychiatrists, hospital cardiologists, inpatient pulmonologists, surgeons, surgery center physicians, hospital pulmonologists, and rounding doctors who work primarily out of acute care hospitals or step-down facilities.

Q. But what is an e/m coding guidelines cheat sheet for hospital inpatient cpt codes?

Casually referred to as an inpatient CPT cheat sheet, the CPT encounter billing guide is just a quick reference visual guide of the simplified codes and the criteria needed to qualify.

And this is not just a newly updated hospitalist billing cheat sheet as it applies to all inpatient specialties that see patients in hospital and inpatient settings. 

For example, a hospital cardiologist sees a patient for the first time and the encounter is super straightforward and takes around 20 minutes. A quick two-second glance shows a 99221.

Done. No weighing other factors or trying to determine whether the context matters.

The encounter code side of the billing is now complete and the resource has been successful. A few minutes saved. The clean claim likelihood significantly raised.

Multiply that by 100 visits in a week and the time saved is tremendous while also providing the repetition the physician needs to turn the new information into a well-honed habit that eliminates the need for the cheat sheet except in the most unusual of situations, speeding up the coding process even further.

Q. Looking to understand the changes in greater depth?

Claimocity offers a white paper and blog breaking down the new structure in clear precise terms, comparing what it was to what it is. The company also has resources with tips, tricks, and industry insights on how to avoid risks and make the most of your CPT billing when it comes to avoiding audits and collecting earned revenue.

“Inpatient physicians dedicate their entire lives to helping patients and performing at the highest levels in an intensely difficult profession.” Jim Sholeff explains, “We believe these doctors should be paid everything they are owed, not just some or most. And we want to give these busy modern professionals the personalized tools they need to document the visit quickly and easily so they can focus on the patient care.”

Studies show that up to 86% of first-pass denials are potentially avoidable but once they are initially denied, one in four of the denied claims can’t be fixed.

Not to mention that the cost to rework a denied claim ranges from $25-$75.

For example:

• An intensivist submits 100 claims for an average of $100 per claim
• Ideally, they should collect $10,000
• Instead, 14 are approved on first pass, generating $1400
• 86 come back denied despite being good claims
• 22 of those 86 are final denials and can’t be reworked, losing the doctor $2200
• 64 are reworked and approved, generating $6400
• But the additional work on the denied claims costs $25-75 per claim
• Instead of 10k, a doctor collects 30-62% and all the losses were avoidable

Getting it right the first time through (first pass) has never been more important and is by far the easiest way to improve bottom-line AR revenue.

The best form of billing software reduces the administrative burden on the physician while providing the resources they need to understand how it works so the doctor and billing team can work collaboratively to check all the boxes to get claims approved the first go-round.

Similarly, understanding 99418s by using the cheat sheet enough for the repetition to kick in allows a doctor to avoid potentially disastrous revenue losses and audit risks while they implement the 2023 AMA changes to the billing guidelines.

Revenue losses are not the only dangers in CPT billing.

Down coding and up coding present two of the most common dangers, and multiple comprehensive data studies show that these coding issues are unintentional and occur as a result of misunderstanding what to put.

Over coding, or down coding, means a doctor collects more than the visit was worth. Down coding, or under coding, means the doctor collected too little. Both are considered fraud regardless of the intention, and patterns of these behaviors trigger audits that can be disastrously costly to a practice.

The cheat sheet is the first step towards alleviating these risks, and when combined with a high-value billing service specializing in the doctor’s medical specialty, audit risks can be reduced down to relatively negligible levels while also increasing E/M benchmarking and peer rankings.

“The stakes are incredibly high and the two most important decisions an inpatient practice manager can make are the software and the billing service,” Jim Sholeff points at the data.

“We offer world-class versions that help doctors thrive with minimal effort,” he concludes, “but our goal is to help every inpatient physician, and our cheat sheets, white papers, free guides, peer ranking assessments, AR audits, and other free resources are designed to finally eliminate all the lost hours and energy bogged down in billing and administrative burdens.”

“Our goal is to help every inpatient physician, and our cheat sheets, white papers, free guides, peer ranking assessments, AR audits, and other free resources are designed to finally eliminate all the lost hours of time and energy bogged down in billing and administrative burdens.”