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About Phoenix88

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    Physician Assistant
  1. Metformin if single digit. Follow up 3 months. Not controlled, look at access to medicines. Let them sell themselves. GLP-1's have the side effect of weight loss. Wonderful. Close follow up if not-controlled, still learning to be compliant, loose follow up if well controlled. If severe diabetes, refer to endo. If you can't do that, weekly follow up with regular glucose testing for insulin adjustments. Start low, go slow. Even if medicaid, they still have access to some of the newer medicines, know how to look at the Medicaid preferred drug list. Diet and exercise always. Recognize if orthopedic/psychiatric comorbidities may sabotage that.
  2. I generally compare their progress with recommended age appropriate milestones. In addition to this, during my exam, or when having a discussion with the parents, I look for the sensory disorder portion. Do they hate bright lights? Loud sounds? Do they always rub against stuff because they crave tactile stimulation? If I have a couple of positives between these, I feel comfortable recommending a neuropsychiatric evaluation. It tends to be easier for me, as two of my children have ASD. While they are not all the same, far from it, there are certain key signs that are easy to recognize if you're familiar with them.
  3. Know the rules behind coding and how much documentation is required. You really don't need a lot of writing for a simple visit. Technically, you don't need too much history for a level 4 visit. If you know the rules, you can make better judgements on how much is enough.
  4. I'm a newish PA, two years, and I've already been audited. It isn't scary as long as you know what you are doing. All I got was a sheet of paper showing me that the auditor agreed with the billing codes that I used. I generally have rules of thumb that help me determine complexity. 99213: (occasional billing) 1 or 2 chronic problems that did not get worse. Also acute problems that don't require drug management. 99214: (95% of time billing) 3 chronic problems (period). Acute problems that require a prescription. Any problem that takes at least 25 minutes of discussion. 99215: (I do bill these infrequently, and I'm comfortable with what I use this for.) Major problems that require a fair amount of work. Imaging, discussion with your supervising physician, most things that you find concerning findings (higher risk) and send to the ER immediately. Also!!!! Patients that require more than 40 minutes of discussion (this does not have to be the same problem). If you bill for time, you should clearly document what your discussion was about. Also annotate if the patient had any issues that caused discussion to go longer than anticipated. (Mild cognition impairment, psychiatric comorbidities.) Sometimes you do more work than what you can bill for, and in these cases remember you have modifiers. You can easily do a 99213 with a 25 modifier to add a simple/moderate procedure that didn't take much time. Earwax removal, sutures, trephination, pelvic exam are some of the ones that come to mind immediately. Another good thing to remember is that the complexity of your visit can help you tailor your notes so you are not _over_documenting. Not that there is anything wrong with it, but it is fairly time consuming. For example, an acute problem for a 99214 requires only 4 HPI elements. So pick 4 of OPQRST or Location/Quality/Severity/Duration/Timing/Context/Modifying/Associated signs/symptoms. A good example of this would be: Patient is a 32 y/o female who presents for the evaluation of dysuria. She has had 3 days of symptoms, which include a 3/10 lower abdominal pain. Her symptoms are lessened slightly with Azo. Complexity wise, this satisfies the 99214 requirement for your HPI. (Do please add any other important details, like fever or other major symptoms.)
  5. It varies. I think it would be easiest to first find out how much each procedure was worth (billed at as well as reimbursed at), and how many RVUs each one was worth. Then find the breakdown of work RVUs (as there are others in there that do not apply to what you did), and use the cost/CPT to calculate what you are bringing in.
  6. CPT codes will be adjusted by your billing department. This is why they exist. If you code incorrectly, they will correct your codes so that the claim does not get denied. They may also find CPT's that you did not, and increase reimbursement. It may be billed under your NPI, or it may be billed under the doctor's. Some insurances will not recognize your NPI and it has to be billed under the doctors. This is not important in the realm of who did the visit. The questions you probably need to ask are, "Where can I view my statistics?" This is a very fair question, as when you have more RVU's, you are being paid more to make more money for your business. (ie: everyone wins)
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