Medical Coding: Review of Systems (ROS)

As providers look for more ways to maximize reimbursement for services provided, they must also consider CPT coding rules and the knowledge and skills of their medical coder and billing service. When coding a claim for medical services all coding rules and guidelines must be strictly followed.

 
When a doctor meets a patient for the first time, especially in the emergency department, the goal is to learn as much about the patient's present and past medical history and concerns by means of the history of present illness (HPI), review of systems (ROS) and past medical, family, and social history (PMFSH).
 
The doctor may ask a list of questions followed by a systematic physical exam, some are limited, others are from head to toe, depending on the individual case and circumstances, which is called review of systems (ROS). This may also be part of an annual physical examination where the doctor is trying to learn as much as possible about the patients health concerns and narrow down any medical conditions, which will then influence immediate course of action and future treatment plans. 
 
There are three levels of system reviews (ROS):
 
1. problem based (only the system related to the patient’s problem)
2. extended (physician reviews several systems)
3. complete (physician must review at least 10 systems)
 
 
The medical coder must review the patient's medical records and carefully read the doctor's entries to identify the level of  ROS and complexity. For coding purposes, CPT divides the body into the following systems:
 
  • constitutional: eyes, ears, nose, mouth, and throat
  • cardiovascular
  • respiratory
  • gastrointestinal
  • genitourinary
  • musculoskeletal
  • integumentary: skin and breasts
  • neurologic
  • psychiatric
  • endocrine
  • hematologic/lymphatic
  • allergyc/immunologic
 
Another area that must be carefully analyzed by the medical coder in the medical chart and then properly coded for accurate billing are unusual, emergency and increased procedural services. For example, an AMA document speaks of coding an incident of birthing room resuscitation, provision of positive pressure ventilation and chest compressions in the presence of acute inadequate ventilation and/or cardiac output using appropriate codes. There are differences between CMS and CPT E/M guidelines and differences between the CMS and CPT requirements for ROS. 
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REMINDER: ASC X12 Version 5010 and NCPDP Version D.0

As of January 1, 2012, medical billing reimbursement claims must be submitted electronically using the new Accredited Standards Committee (ASC) X12 Version 5010 standards for Health Insurance Portability and Accountability Act (HIPAA) transactions. Implementation of HIPAA Version 5010 will require changes to software, systems and perhaps procedures that you use for billing Medicare and other payers.
  • Level I compliance means "that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing." 
  • Level II compliance means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards."
  • HHS permits dual use of existing standards (4010A1 and 5.1) and the new standards (5010 and D.0) from the March 17, 2009, effective date until the January 1, 2012 compliance date to facilitate testing subject to trading partner agreement.

It is extremely important that all medical billing staff and consultants are aware of this HIPAA change and in compliance.

Medical Coding School Graduates Searching for Jobs

Searching for a job, and not landing a desired position fast enough, can be a painful experience. Here are a number of things that you can do to increase your chances of success. 

In our very active Web forum for medical billers we often hear from a surprising number of medical coding and billing school graduates who are not able to find a job upon graduation. Many of them are getting frustrated quickly since they have a family to support and bills are pressing. After all, they went back to school to make money! Searching for a job, and not landing a desired position fast enough, can be a painful experience. Here are a number of things that you can do to increase your chances of success.
 
One visitor posted to our Medical Billing Community forum on: January 18, 2011, 12:02:59 AM:
 

"What is the job outlook as far as working as a medical biller?"

The best answer was posted by Steve: "That all depends on where you are. Just looking for a job took me 3 years and I have 39 years of experience and more initials after my name that the letter board above the chalkboard. I had to take 3 preemployment tests before any interview. Everything depends on what is opened where you are and if a doctor will hire you let alone trust you with his business. I just met with 4 doctors this past month; all fired their coders and billers due to loss of practice revenue due to their inability to properly file and follow up on claims…  but, it's like a baseball game.  You can have 3 quick strikeouts in an inning, or 100 homeruns, or it can be a lush tropical paradise or a desert with tumbleweeds.  In other words, one never knows unless one investigates their individual area and what each doctor wants.  I can only tell you about my area and its a desert. Even Walmart isn't hiring here."
 
There you have it! Straight from the expert's mouth! A forum is an excellent platform to discuss issues and concerns and network with others already working in the field, however, just sounding-off and doing little else will not solve the problem, which is finding a job to pay off student loans and pay the bills.
 

Qualified Medical Billers and Coders Searching for a Job

Finding a job should be approached like working a full-time job, because in so many ways, it is. If you had a job, you would report to work at the same time each day early in the morning, take an hour for lunch, and quit at the same time in the afternoon. You would work five days every week and you would work hard to accomplish as much as you could because your career depended upon it. When you are searching for a job, you should follow the same schedule; your future depends upon it.
 
So, begin tomorrow by reporting to work and spending the day on tasks that lead to landing a job. You should apply all of the tools and skills available, since landing your first medical assistant job is an important project. The sooner you complete it, the sooner you will hold your first medical assistant pay check.
 

Job Search Tip: Be Creative, Systematic and Persistent

Be creative, go about it methodically and stick to a system. 
1. Set goals for yourself
2. make plans
3. monitor your progress
 
It might sound a little odd, but pretend to be your own boss. Set expectations for what you need to accomplish, provide direction, and monitor your work. 
 
"Meet" with yourself once each week to evaluate your performance. I recommend doing this in writing, such as in a simple journal. Make a candid evaluation of what you have accomplished during the previous week, write an evaluation of what you have done so far, describe the results this effort has produced and compare these results with what you wanted to accomplish.
 
Next, refine your plans for the coming week. Your plans should include your goals, actions, and priorities. Next, map out a realistic plan for the next week based on achievable goals. For example, you could set goals for the number of people you will call, the number of networking meetings you will attend, and the research you will conduct.
 
In the coming weeks, compare the results from the previous week with the goals that you have set. For example, if you planned to send out twenty resumes and you mailed only two, you should:
 
a) explain why this happened
b) plan actions to correct the short-fall
 
You should also analyze why you missed your goal because this provides insights on what you need to do differently, for example, your goal may have been set too high, or maybe there are things you can do that will make it easier to achieve your job search goals, such as car pooling with a friend who is also looking for a job. Check this list of daily updated jobs for  medical billers straight from the Indeed.com.
 
 

Medical Coder Salary and Income Comparison Charts

AAPC has published a detailed article and charts on their website that shows how much medical coders can earn along with a separate list of salaries by specialty and salaries by title. Furthermore, the website emphasizes that location affects the medical coder's wages, along with the cost of living, urban vs. rural setting and regional economic pressures. More than 10,000 members responded to the AAPC annual salary survey:

  • CPC-I $68,593
  • CPC-P $55,172
  • Specialty $53,725
  • Multiple Specialties $52,777
  • CPC-H $51,980
  • CPC $45,253
  • Certified $44,740
  • CPC-A $34,699
  • Non-certified $…….

Healthcare Adds 41,000 Jobs

The government issued its September 2011 jobs report on Friday. Last month's report by the Department of Labor included several positive signs, among them that the average workweek rose to 34.3 hours from 34.2 hours, reversing a decline in August. Economists estimate that employers added  56,000 jobs last month and the unemployment rate remained stuck at 9.1 percent for the third straight month. On a positive note, the ISM's employment index for the manufacturing sector rose, suggesting factories added jobs last month, however manufacturing accounts for only about 10 percent of U.S. employment and can't boost hiring by much on its own. Several strongly performing industries continued to lead in job growth. Professional and business services added 48,000 jobs, while healthcare added 41,000. The average hourly earnings jumped to $23.12 from $22.08.

 

Building a Medical Billing Business From Home

We have discussed this topic a few times, including on our Medical Coding and Billing Blog, for most who eventually started their own medical billing business from a home office it was not something that happened overnight. They have been in the field as an employee with trusted employer relationships for years, and have made contacts with doctors and clinics who have earned their trust. This would be the point where one could say: "Doctor So-and-so, I am looking for opportunities to do this job from my home office. Would you allow me to take some of your billing home."

So, in a nutshell, your education counts, experience counts, employee relationships count, and trust and references count. Then, when you have all this under your belt make sure your resume is updated and shines, also make sure you have researched and know local and state laws as to what is required via city ordincane and zoning, and such, to run a home business. Find out how to incorporate your business. Although you could "freelance" it, an LLC provides you with a certain amount of protection.

medical billing and coding from home
Defining the Medical Biller's Role

Medical Coding Latest Updates and Announcements

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This is our most active page in this navigation sequence that present and future medical coders should bookmark and revisit often for important updates.

We will continuously update this page with latest medical coding news from well known medical coding publications with articles, and dates for medical coding workshops and seminars. Regular reading of medical coding publications and announcements, as well as attending workshops and seminars keeps your medical coding knowledge and credentials current and you on top of current issues and important changes.  For example, there will be major changes in the International Classification of Diseases, 10th Revision, Clinical Module (CD-10-CM). CD-10-CM This will be a huge change for diagnosis Coding when it becomes effective in 2013. In your role as a medical coder you need to be prepared for this change so that you don't fail the providers who depend on you for their practice's success. 

Consider voluntarily sitting for qualified medical coding certification exams to earn industry recognized credentials…

Speaking of medical coding credentials, we cannot emphasize it enough at this time there is no license, degree, or certification required to work as a medical coder.  Unlike physicians, surgeons, nurses and other licensed medical professionals who are governed by the State Medical Board/Board of Medical Examiners, a governing body of the medical coding and billing field does not exist. This is not to rule out that government health insurance programs, such as Medicare and Medicaid, might change the rules, but at this time, anyone who believes, or states that they must be "nationally certified" or have specific credentials before applying for a medical coding positions is misinformed. Here is what you need to know…

Medical coding is a career with excellent wages, benefits and promotions and bears great profit-making potential for those who wish to start their own consulting services or business.