Bill Klaproth (Host): This is an AAOMS On the Go Podcast. I'm Bill Klaproth, and I'm pleased to welcome with me Dr. Adam Pitts. Dr. Pitts is past Chair of the AAOMS Committee on Healthcare Policy, Coding and Reimbursement and currently an ADA advisor to the CPT Editorial Advisory Committee as we talk about AAOMS coding and billing courses.

Dr. Pitts, welcome.

Dr. Adam Pitts: Thanks, Bill. Glad to be here. Excited to be able to impart some knowledge to anyone who wants to know a little bit more about coding and billing and how it can affect their practice.

Host: I love it. And that's exactly what we're looking for. So, Dr. Pitts, what is coding, and how does it relate to provider reimbursement?

Dr. Adam Pitts: Coding in general is just a process of converting a patient's diagnosis, medical, dental procedures into some type of a standardized alphanumeric code. Think of it almost like building the Assessment and Plan portion of a History and Physical. It's a concise description of the patient's underlying conditions, i.e., their diagnosis and the treatment, i.e., procedures that are going to be required. The codes should reflect the provider's medical and dental record and the documentation that's been performed. It's going to include anything that could be on an op report, on evaluation notes, even lab results, imaging. The codes themselves are maintained by a few different organizations. The AMA actually maintains the CPT code set. The ADA maintains the CDT code set. And then, technically, the Center for Disease Control, the CDC, maintains the diagnosis codes that we use on the diagnosis side.

Host: That's very interesting. You guys are the expert, of course, in oral surgery. You go through years of training, extensive schooling, and then you got to learn how to code. So, I'm wondering, do many oral and maxillofacial surgeons code their own claims or even know how to code?

Dr. Adam Pitts: The short answer is probably doubtful, unfortunately. I mean, even though every surgeon is exposed to coding during the residency program, many times it's more of a tracking tool as opposed to something you truly understand. Any residency programs require some type of tracking logs so they can evaluate a resident's performance just from a numbers of procedures. But to actually take that and put it into knowledge and practice is something that's probably not done as much as it could be. Some oral surgeons actually do their own coding. Some might actually prefer to collaborate with their coding and billing staff where the surgeon actually kind of starts it out and then transfers it over to the staff.

Historically, or classically, surgeons used to use something called an encounter form. And I think a lot of people might even know what that was, where you'd see a patient and then on some piece of paper you would manually checkmark a line item and then hand that to some billing staff in your office, which would transfer that to some billing software to be transferred to an insurance company. That obviously has gone by the wayside and now we have more robust practice management software systems and electronic health records that have taken over the role of the encounter form. But the basic function is still the same. It's to translate the diagnosis procedures into a code that can be submitted to either an insurance carrier or for other tracking information.

Host: So, I imagine working with insurance companies, there's a lot of codes that you have to know. So, how does the coder, billing staff, or surgeon know which codes best reflect what service was rendered?

Dr. Adam Pitts: Well, it's a good question because there's a lot of different people involved. A professional coder undergoes extensive training to understand exactly which code to use, but their job is still predicated upon the appropriate documentation by the surgeon. So, documentation is absolutely critical by the surgeon.

So even though someone else might be doing the coding, the documentation whether it be an op report or a dictation or even just manual transcription of a diagnosis into the patient's chart is still so important from the surgeon himself. There's a lot of layers to accurate coding. It's not merely this direct conversion, kind of like converting language from English to Spanish. There are several layers. For example, if you think of something as commonplace as like a mandible fracture, like every oral surgeon knows how to treat a mandible fracture. And honestly, most would agree there are probably several types of mandible fractures. I doubt most surgeons would know that there's over 75 different diagnosis codes for a single mandible fracture. And so, a lot of layers go into that code and they are all driven by the surgeon's documentation.

Host: When you say there's a lot of layers, that's a lot of layers. I like how you said it was like converting English to Spanish. So, that seems like a lot to deal with. So, how does AAOMS jump in here and help members navigate all of this?

Dr. Adam Pitts: AAOMS does a great job of providing resources for coding and billing to all their members. We got websites. There's a series of coding and billing courses that are offered. The education they provide is not just for some magical billing expert or some expert coder. They really have options for all levels of experience. I know in our office from the very basic first-day hire, someone who has zero experience in oral surgery, much less coding, there's even resources for them to start there.

All of these courses have been approved for continuing medical and dental education. And so, not only is it appropriate and a good use of a surgeon's time, but also they can get the appropriate credit if they need that for their state requirement for CME or CDE.

And then, for those that really want to kind of take it to the next level, there are masters level coding and reimbursement workshops that are held at AAOMS headquarters. We have the Beyond the Basics workshops, which kind of travel around the country. And all these courses have the one underlying goal in mind, and that's to make you a better coder and biller, and make your practice a more efficient and profitable center, to actually translate what you're doing with your hands into something that can go on a claim form and ultimately result in providing for your family.

Host: Which is really, really important, getting those codes correct. Would that be right, Dr. Pitts?

Dr. Adam Pitts: Absolutely. I think that, like you said earlier, you could go in and do some direct conversion with some basic codes. But as you'll see, when you get a little bit deeper into it, or you get a denial from an insurance company, it might be because of one of these specific layers having to do with whether or not a code was provided at the same time of another service, whether it was inclusive, whether it was one site or multi-site. There's a lot of layers that go into that and being able to understand that truly affects the way that you'd be able to get reimbursed.

Host: Absolutely. You want to make sure that you're fully reimbursed for everything you do, and it sounds like having the proper codes is vital to that. You're so knowledgeable on this, Dr. Pitts. I'm happy that we have you on the podcast today. So have you personally participated in any coding courses with your staff?

Dr. Adam Pitts: Absolutely. I actually attended my first workshop when I was still a resident. And certainly these are available for residents and it's still a good resource for residents or certainly with newly graduated oral and maxillofacial surgeons. But I personally brought my staff to the course. And again, brought the staff at all various education levels. Because at the course, you're going to get something for whatever level you're at, whether it be someone brand new in the office or someone who's been doing it for 10 years. All of my staff have attended the Beyond the Basics course and really felt like they got a lot out of it and were able to ask specific questions that were pertinent to our practice that directly affected reimbursement immediately after attending that course. And so, the course literally paid for itself within a few weeks. 

Host: So you said it's good for any level of knowledge that you have of coding. So, for those who may have already taken a course in the past, is there any advantage then to taking it again?

Dr. Adam Pitts: Absolutely. Number one, I'm sure you're going to have new questions and new wrinkles that have come up with dealing with payer questions and denials. Also, the fact that the code sets themselves change annually. So, if you took a course two or three years ago, there's vastly different codes that exist and different reimbursement policies that have been made since the last time you took a course.

And so, just like anything, it's exceptionally important to stay up on the regulations as well as the changes, and these changes are quick. There's certainly been a lot more changes in the last five years of billing, coding, and reimbursement than there has been in the actual procedures that are performed. 

Host: Yeah, it sounds like it's really important that you keep up with all of that. So, I would imagine then that coding courses have provided you with information that you've used in your own practice to improve reimbursement. Would that be right?

Dr. Adam Pitts: Absolutely. In our practice, we've used it almost on a daily basis. We have actually a laminated sheet that has answers to questions that we asked at a course, and we're able to kind of keep the computer for kind of a frequently asked questions. Also, we've been able to do the same thing with some of the FAQs that are on the AAOMS website and download them and have them actually available to flip through and look at as a resource for immediate usage. 

It's tough because if you look at the data, less than 10% of oral surgeons participate or attend an AAOMS coding course. And so, I really think that a lot of those surgeons and those practices are likely leaving a lot of reimbursement on the table, just by not understanding how to appropriately bill and code. 

Host: Well, I think you just said something really, really important. A lot of OMSs are leaving money on the table by not properly coding, by not taking the time to learn this or having staff members learn this. So, I mean, really, really important things that you're talking about, Dr. Pitts. This has really been informative, and I think the bottom line is, if you don't know about coding, educate yourself on coding or make sure that your staff is educated on coding as well. Before we wrap up, Dr. Pitts, is there anything else you'd like to add?

Dr. Adam Pitts: Oh, I think we've looked through the data and some specific carrier problems that have come up over the last few years and noticed that specifically, if you had an oral surgeon who went to or had his staff go to one of our coding courses, like Beyond the Basics course, we’ve potentially shown that you could produce over $8,000 more in reimbursable revenue per case if using modifiers correctly when billing for certain procedures. We've also estimated that OMSs who inadvertently billed for anesthesia time, which maybe they weren't personally present or didn't do it appropriately, could have potentially overbilled for things and be opening themselves up to liability or litigation. And so, not only is it reimbursement, but it's doing the right thing and protecting yourself as a surgeon. And so I think there are just so many avenues with which correct billing and coding affects our daily lives, our daily practice, and our future as oral surgeons.

Host: This has really been fascinating, Dr. Pitts. Thank you so much for your time. I really appreciate it. 

Dr. Adam Pitts: Thank you, Bill. Had a great time. And I look forward to any questions that might come up as a result of this podcast. Thanks again for the time.  

Host: You bet. And once again, that is Dr. Adam Pitts. And for more information, you can also visit AAOMS.org/CodingBilling. Once again, that's AAOMS.org/CodingBilling. I suggest you go there as well. And if you enjoyed this podcast, please share it on your social media and make sure you subscribe so you don't miss an episode. Thanks for listening.