primary care docs, i want your input/opinion/answers..how much do you gross per day?

[childay]

I'm psychiatry and pretty much only bill 99214 for follow ups but they're all 30 minute appts!

Generally no reason for lower than 99214. Maybe we should have done FM?

[StarTrekDoc]

Generally no reason for lower than 99214. Maybe we should have done FM?

The time requirements are much improved and welcomed for those who do a lot of VBC work on the same day of visit.

Even with the revised rules, there's remains a serious distance between 99214 and 99215 and need for 99214.5

[familydocPA]

Agree, the level 4 visits are very easy to obtain with the new rules. But it is very difficult to get a large number of 5's. Almost all of my level five visits are based on time (clearly not something the OP is doing). I find it hard to believe that the OP is meeting the medical complexity requirements with such short visits, but I'm sure they will deny this.

[Savedfpdoc]

Agree, the level 4 visits are very easy to obtain with the new rules. But it is very difficult to get a large number of 5's. Almost all of my level five visits are based on time (clearly not something the OP is doing). I find it hard to believe that the OP is meeting the medical complexity requirements with such short visits, but I'm sure they will deny this.

Yup denied.
Also forgot to mention I increase the rvu by billing regular office visit AND physicals for the same visit ..this is only done for commercially insured , traditional Medicare, traditional Medicaid patients.

[gap55u]

I do a lot of 99214.999’s - addressing multiple chronic problems adjusting mult meds. One way to see more patients is to say hey I saw you for your 99214 HTN cholesterol, come back next week for your diabetes depression. Both easy visit, but not a patient satisfied. Medical complexity: uncontrolled htn 150/100 and uncontrolled DM A1c 12. Adjust htn meds and start insulin. 99215? I feel it should be, but my reading of complexity/risk for high MDM says no. (I would clearly label that visit, adjust HTN meds, add a glp-1, a 99214).

[Savedfpdoc]

I do a lot of 99214.999’s - addressing multiple chronic problems adjusting mult meds. One way to see more patients is to say hey I saw you for your 99214 HTN cholesterol, come back next week for your diabetes depression. Both easy visit, but not a patient satisfied. Medical complexity: uncontrolled htn 150/100 and uncontrolled DM A1c 12. Adjust htn meds and start insulin. 99215? I feel it should be, but my reading of complexity/risk for high MDM says no. (I would clearly label that visit, adjust HTN meds, add a glp-1, a 99214).

99215…close blood sugar monitoring would be enough to meet the “intensive monitoring “ component of. The guidelines don’t say it needs to be a swan ganz..etc

[StarTrekDoc]

99215…close blood sugar monitoring would be enough to meet the “intensive monitoring “ component of. The guidelines don’t say it needs to be a swan ganz..etc

Unless there's ketones/risk of hospitalization near term, it's hard for that alone 99215. symptoms of HTN urgency, or CHF flaring or significant COPD risk or DM with ketones, and +polys with new A1C high -, yes 99215. chronic a1c 12 and titration or COPD with simple changes? 99214 even combo.

Agree, one can juice this and do weekly FU 99214s rather easily. That's where VBC will be negatively impacted and those in systems that's beyond just RVUs will have structured systems and models to reflect efficient work and care delivery and appropriate support structures. In primary care, with the alternative payment models in play, a system with ACO exposure would benefit a lot more than this over simple RVUs. Insurance companies in MAP understand this quite well -- as well as systems like Kaiser have benefited dramatically

[Savedfpdoc]

10 pts in 2 hrs this am. All 14s

[HikingDO]

10 pts in 2 hrs this am. All 14s

That’s really nothing to be proud of.

[Savedfpdoc]

That’s really nothing to be proud of.

Your making a judgement without any factual information, I think that’s nothing to be proud of.

[HikingDO]

Your making a judgement without any factual information, I think that’s nothing to be proud of.

I’ve been an FM doc for 25 years. Seeing 10 99214s in 2 hours is not good care. I’m sure you’ll disagree, and I’ve worked with several FM docs in the past who’d say the same and also disagree with me, but they also didn’t give great patient care. Maybe you’re the unicorn and the exception to the rule, who knows, and if you are, I apologize.