TMA Case Study: Coding and Documentation

Correct coding can help you avoid delayed and incorrect reimbursement. Tracking your practice’s coding patterns can both reduce the risk of an audit due to over-coding, and help prevent lost revenue due to downcoding. On average, practices lose 10 to 30 percent of potential revenue due to incorrect coding; downcoding in particular can cost a single doctor $40,000 in lost revenue each year. Here’s an example of what this looks like for a small practice.

Practice: Solo pulmonologist in a small rural community

·         Challenges: Physicians receive very little formal instruction on appropriate medical record documentation and on procedure and diagnosis coding.

·         Action: The physician requested TMA consulting assistance to review his encounter documentation and code selection(s). Findings indicated the physician’s error rate was 70 percent, meaning documentation did not support the level of service reported.

·         Outcome: After studying the consultant’s report and receiving hands-on training, the physician had a follow-up review. His error rate improved to 20 percent. The TMA consultant also identified the physician’s missed opportunities to capture nearly $95,000 in revenue.

TMA’s certified professional coders and auditors can perform an in-depth review of medical record documentation and claims coding that identifies any deficiencies and areas of risk. The review helps streamline coding and documentation processes, and decrease the risk of external audits. Additionally, up to 20 AMA PRA Category 1 Credits™ per physician can be earned when a coding and documentation review is performed for your practice. 

Need coding help? Contact TMA’s practice coding experts with questions: practice.consulting@texmed.org, or (800) 523-8776. Or, visit the TMA website for additional coding resources and information.