Capturing All the Work

Question: I have a problem with the way my group values physician services. The RVUs for the E&M and surgical procedures work, plus the RVUs for the professional component of things like X-rays and some medicine in-office procedures, are tallied up to represent my “work.”

All kinds of things get missed in this fashion. The work I do in the clinic to get a patient admitted is lost when our hospitalist admits them. If I go see a patient in the labor and delivery area - an outpatient department - after I’ve seen them in the office, I lose that. If I round on a patient in the morning when I’m covering for someone, and one of their partners also stops in later, I lose that too. This method just doesn’t cover a lot of the work that I do. Any suggestions?

Answer: Well, RVUs aren’t the perfect way to capture all your work, but I don’t know of a better one. When you allowed the hospitalist role in your group, you essentially gave up that piece of office work - along with trips to the hospital.

However it sounds like you’re still going to the hospital. In the labor and delivery example, you essentially have two outpatient encounters in the same day - in different places of service, outpatient office and outpatient hospital. Here you might try and add these with prolonged services codes, but the likelihood is that they’ll be denied due to the site of service codes. This is one of those cracks in the system.

As to covering and multiple visits by the same specialty or provider taxonomy code on the same day, you’ve encountered another occupational hazard. Is the other provider just “social calling?” Your note should trump his/hers if you are doing the work. Appeal it.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or physicianspractice@cmpmedica.com.

This question originally appeared in the March 2010 issue of Physicians Practice.