The issues are accuracy and efficiency. A clinician must deliver to their coding staff an accurate description of services rendered and coding staff must translate this into an appropriate procedure code. A pervasive coding error is either a significant revenue problem due to failure to capture an appropriate charge or a significant compliance problem due to inappropriate upcoding. Most qualified coding professionals strongly recommend that clinicians code their own procedures whenever possible. You may be surprised at how much time your staff is taking to figure out what you did. Underpayment may also result from failure to account for details that qualify for a higher-reimbursement code. A clinician may not even know about the availability of higher reimbursement and, therefore, might not even document these details. STAT CPT Coder shows the clinician all of the available coding options along with the RVU value for each.
Total memory required for all files is about 900K. STAT ICD-9 Coder and STAT CPT Coder databases should be installed to handheld memory for optimal use (not to memory cards). If you fully understand how to manage files on memory cards, however, the individual folios (.pdb files, not TealInfo.prc or TealDoc.prc) may be moved to one-by-one to external memory using the TealInfo "Mov" function. Doing so will add about 1 or 2 seconds to the time needed to open each folio. You should move all or none of the folios since they are linked together and will only find each other if they are in the same memory. For the search function to work, you must also use TealDoc to move or copy the STAT CPT Search.pdb document to the memory card. Also, TealInfo will only remember the last folio that you opened up when you are using the handheld memory i.e. it will start with the Menu folio if you opened it last. If you see "Cannot find XXX database" errors when switching folio's, you probably have not moved every database to the same memory (all on handheld memory or all on memory card).
The Relative Value Unit (RVU) is the common scale by which practically all physician services are measured. CMS and most other insurers use RVU values to determine the reimbursement rate for services after incorporating geographic and other factors. It is included for clinicians for comparison purposes only. The RVU information included is derived from the CMS National Fee Schedule Relative Value File. This is a combination of the Physician Work RVU, Practice Expense RVU, and Malpractice RVU for services where the facility costs are not being paid elsewhere. It also incorporates a transition from the charge-based Please refer to CMS RVU information or qualified coding professionals for more details regarding the interpretation of this data. More details from CMS regarding RVU's and the national fee schedule is included in an addendum at the bottom of this page.
Modifiers are not included in this reference tool due to their complexity and ambiguity. There simply is no short-form to guide clinicians in the use of modifiers. Anyone coding modifiers should refer directly to the full text of the CPT™ codes and obtain further guidance from qualified coding professionals.
STAT CPT Coder divides the surgical procedure codes into individual organ system categories which can be selectively installed according to the needs of the user. Software that restricts the user choice of procedure codes were recently identified by the Office of Inspector General as a compliance risk by facilitating inaccurate coding. For more information on this, read the March 2000 OIG report on medical billing software (pdf format). Coding with less specificity also may result in underpayment due to failure to account for details that qualify for a higher-reimbursement code. A clinician may not even know about the availability of higher reimbursement and, therefore, might not even document these details.
Registration of TealInfo™ is not included. TealInfo™ is a shareware product of TealPoint Software. It is the database product that is used to display the STAT ICD-9 Coder databases. The demo version included with STAT CPT™ Coder has a one second opening screen requesting that the user register the software for $16.95. TealDoc can be registered in an identical manner.
All upgrades to this software involving the current CPT™ book are included. However, future yearly editions of the STAT CPT™ Coder will require another licensing fee paid to the AMA for each copy of software sold. Therefore, upgrades of this software to incorporate future CPT™ editions are not included. Currently, yearly updates are $25.
No. This application is specifically tailored to the Palm OS platform for handheld computers. Why would you want to hold a PC in your hand? No Windows CE / Pocket PC version is available at this time.
Andre S. Chen, M.D. is board certified in Family Practice, received an MBA from the University of Texas at Austin, and practices with a multi-specialty group practice in Austin, Texas.
Plan for 8 megs or more for any clinical application. Software from statcoder.com occupies no more than 1 meg in total, however there are there are larger reference applications which no clinician will want to be without. STAT E&M Coder and the other software available from this company will run on even the lowest priced Palm OS handheld. These include handhelds from PalmOne View our compatible PDA page which contains pictures and web links.
The following is an excerpt of documentation from CMS that is included in the RVU information that is incorporated in this software. Only a small portion of this data is included in STAT CPT Coder. NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE CALENDAR YEAR 2000 This file contains information on services covered by the Medicare Physician Fee Schedule (MPFS) in 2000. For more than 10,000 physician services, the file contains the associated relative value units, a fee schedule status indicator, and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.). The Medicare physician fee schedule amounts are adjusted to reflect the variation in practice costs from area to area. A geographic practice cost index (GPCI) has been established for every Medicare payment locality for each of the three components of a procedure=s relative value unit (i.e., the RVUs for work, practice expense, and malpractice). The GPCIs are applied in the calculation of a fee schedule payment amount by multiplying the RVU for each component times the GPCI for that component. For informational purposes, changes from the previous year=s documentation file are in bold font to facilitate their identification. Section 121 of the Social Security Act Amendments of 1994 required CMS to replace the existing charge-based practice expense relative value units for all Medicare Physician Fee Schedule services with new resource-based ones. The Balanced Budget Act of 1997 requires a four-year transition from the existing charge-based system to the new resource-based system beginning on January 1, 1999. In 1999, the practice expense relative value units are based on 75 percent of the charge-based system and 25 percent of the resource-based system. In 2000, they are based on 50 percent of the charge-based system and 50 percent of the resource-based system. In 2001, they are based on 25 percent of the charge-based system and 75 percent of the resource-based system. In 2002, the practice expense relative value units are based entirely on the resource-based system. Under the charge-based system, we had a policy that reduces the practice expense relative value units for certain services by 50 percent when they are performed in a facility setting. Under the resource-based system, this policy is no longer applicable because, where appropriate, we have developed practice expense relative value units specific to the facility and non-facility settings. Generally, under the resource-based system, the facility practice expense RVUs will be used for services performed in inpatient or outpatient hospital settings, emergency rooms, skilled nursing facilities, or ambulatory surgical centers (ASCs). The non-facility practice expense relative value units will be used for services furnished in all other settings. Note: A procedure performed in an ASC that is not on the ASC list is reimbursed on the basis of the non-facility practice expense relative value units. Outpatient rehabilitation services usually will be reimbursed on the basis of the non-facility practice expense relative value units. We did not develop non-facility practice expense relative value units for some services which, either by definition or in practice, are never (or rarely) performed in a non-facility setting. For example, by definition, the initial hospital care codes (CPT 99221-99223) are provided only in the hospital inpatient setting. Also, many major surgical procedures with a 90‑day global period are almost always performed in the hospital inpatient setting. These facility-only codes are identified by a >NA= in the >NA Indicator= field. In 1999, the implementation of the practice expense transition was implemented in the fee schedule calculation formula. In 2000, to eliminate confusion, the calculation formula will use the transitioned practice expense value. The payment formula for 2000 is as follows:
2000 Non-Facility Pricing Amount = [(Work RVU * Work GPCI) + (Transitioned RB Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor 2000 Facility Pricing Amount = [(Work RVU * Work GPCI) + (Transitioned RB Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor The Medicare limiting charge is set by law at 115 percent of the payment amount for the service furnished by the nonparticipating physician. However, the law sets the payment amount for nonparticipating physicians at 95 percent of the payment amount for participating physicians (i.e., the fee schedule amount). Calculating 95 percent of 115 percent of an amount is equivalent to multiplying the amount by a factor of 1.0925 (or 109.25 percent). Therefore, to calculate the Medicare limiting charge for a physician service for a locality, multiply the fee schedule amount by a factor of 1.0925. The result is the Medicare limiting charge for that service for that locality to which the fee schedule amount applies.
| 
