We do have some time now for questions and answers. If there are any Q&A, if there are any questions, please put them in the Q&A box at the bottom of the Zoom screen as opposed to the chat. Just wanna make sure we capture all of them. We do have one to start with. When ordering a colonoscopy, I think this is relevant for Jill, when ordering a colonoscopy, what level of billing is that? I think the initial question was with regards specifically to a screening colonoscopy, if I'm not mistaken. Yeah, so screening colonoscopies from an ambulatory-based, so I'm assuming that a patient is in your office and you're getting them ready for a screening colonoscopy. So there's no billable E&M code for a screening colonoscopy. In a scenario where a patient is elderly and you have to manage their, say, anticoagulant therapy, or if they just came back from a hospitalization, then you can use time-based coding for that and do a E&M code, but for straight screening, and there's no comorbid conditions, there is no coverage for that. That's a no charge. Thanks, Jill. We do have another question. This is directed at Jill. We'll keep moving. Jill, how do I become you? I have been an APP for many years and feel I do an okay job with billing, but want more knowledge or formal education in this arena. What is your advice on how to get started to supplement my knowledge? So start by reviewing the guidelines. So there's a link in my references, and it says 2021, but those guidelines have not changed. So focusing on your problem, your data, and your medical decision-making. Also, depending on what type of organization you're in, rely on your resources of your coding resources. So you should be having at least an annual audit and they should be going over the coder, professional coders should be going over that information with you. And also I recommend doing peer-to-peer chart reviews with each other. Identify someone in your department that has a good track record, that passes their coding audits, and sit down and go over notes with them. And there's a lot that you can learn from each other by understanding that. Other courses. You can, I mean, from an advanced perspective, you can join the American Academy of Professional Coders. You can look at joining American Health Information Management. I have to join them to maintain my certifications, but my disclaimer is, I'm not a practicing professional coder though, but these are additional resources that I see. But then looking, definitely utilize your internal organization resources. Thank you, Jill. Another question, we have a couple more questions coming through. My HPI is very quickly typed, but then summarized in the assessment. How brief should I be in the HPI if I'm doing time-based coding? You know what the rule of thumb is, you document as much information as you need to care for the patient. So the new change in the guidelines, we're not counting bullet points anymore. There's no determination on exactly what type of physical exam that you're doing that's as medically necessary. But your HPI, you need to document as much information that you need to describe the patient's story. Thanks. I have one in the chat, I think came next, and then we'll come back to the Q&A. For MDM, would ordering an endoscopic procedure be moderate? When would this be considered high? Well, look at the slides that I provided. If you look at moderate medical decision-making, it's gonna be discussing and reviewing endoscopic evaluations or surgery. When you get into the high, those are gonna be your patients that have morbid obesity, BMI 50, and you have to coordinate them to be at the hospital. So they're sicker patients. So the guidelines actually do give you some examples, which are good. That's great. The more complexity that goes into that decision-making. Absolutely. Should we avoid using ICD-10 codes that include the word unspecified? Yes. Yes, absolutely. I think you answered this also, to be as specific as you can with your diagnosis. As specific as you can will get you better diagnostic decision-making. Correct. Think about when you're ordering a breath test for small bowel bacteria overgrowth. What is one of the diagnosis codes that's covered for rifaximin? It's IBSD. So you need to make sure you're using that diagnosis code if it's appropriate for your patient. Excellent. Another question. This is with regards to the G2211 code. So our biller informed us that only one provider can use this code per diagnosis. So as an example, PCP cannot add this for GERD in addition to GI. Furthermore, she mentioned it must be a lifelong disease, more like IBD. Does this align with your understanding as well? Yes, but I consider GERD a lifelong disease, actually. I mean, there's waxing and waning. So I don't consider people necessarily cured. Just because, remember, just because you're on a medication to control a symptom doesn't mean that the disease goes away. It just means that it's controlled. You can only one, geez, how would they track that? That's really interesting. If a family practice use the visit, the G code for the GERD, but not the gastroenterologist. That is correct that only one specialist can use it for that diagnosis. So, but that's interesting on how organizations are even going to track that. I think that's one of the deficiencies in utilizing some of these codes. Additional examples of codes are transitional care management codes or chronic care management codes. And these are one-time codes per specialty as well. Great points. Great points. We're just learning how to properly use that code as well. Another question towards artificial intelligence. Have you implemented AI for note documentation like DAX? I'm not familiar with AI for note documentation myself. I have actually, I have. I've been using it for three months now and it will give you a huge HPI. So what we've turned into now is we're not authors anymore. We're editors and it gives you so much information. And I almost have a love hate because it gives a great history, but you know what's very humbling is that it will, it captures information. And if you end your recording and start adding in your records, then it's gonna come up real time. And I will look at snippets of information in the HPI and I'll say, did you tell me you were leaving for Australia next week? And she's like, oh yeah, I did. So it's amazing how much they capture, but you're not hearing. I'll tell you, in our large organization, we have some primary care providers that are not using it because they're worried about liability because all this information is gonna be stored in the cloud. And how much of that is retrievable? From my understanding, it's not gonna, it's only there for X amount of time, but I still don't know how long it's there. But it does a long HPI, but the assessment plan I'd love because at bullet points, just like Dr. Tawani, you had given a documentation example of the GERD and another problem. You know, it does a great job bullet pointing. I've been using it for a similar timeframe, Jill. And I think I actually have maybe the opposite opinion. I really like it for the HPI. I do think we're editors now, but it captures it fairly well. I think it's probably more detailed and accurate than what I was doing before. I tend to turn it off for the assessment and plan because it's just not what I'm looking for. And so it's still a learning curve on my part, especially in like sub, sub specialized GI. I just feel like I haven't quite figured out how to capture my assessment and plan as accurately and complete as I'd like it to be. You know, especially when we start to talk about complex ERCP and risks and benefits. And, you know, the fact that we started the informed consent process, I feel like I haven't quite figured that art out yet. Sometimes I find that I'm changing my behavior based on the technology that I'm using. So I will start to talk to my patients as I want the DACS to pick up and be written in the assessment plan. So you could try that as well. And supposedly these artificial intelligence technologies, right, they should learn from your experience and learn what works best for you as you use it more and more, so. They should, but there's a common phenomena called hallucinations that artificial intelligence will make up information that it sounds, that it fits within the flow of what it's trying to dictate for you. So it's important to definitely audit your work. I mean, I have a portal message waiting for me to answer of a patient several weeks ago who it was, my patient was an 18 year old, but her mom was in the exam room as well. And the mom was very talkative and they both were describing about their chronic constipation. And my patient said, I've never taken Seneca before. I think that was my mom that was in my note that was taking the Seneca. So I'm going to have to go back and re-review that. Maybe something I missed in my editing. Right, right. If there's two people giving the history, it may not differentiate the two. Right. We did have a couple of attendees with their hands raised. I didn't know if there were specific questions they were trying to address. Please, if you do, please put those questions in the Q&A as well. We have another question. Do any of you have specific verbiage or phrases or effective strategies you use for patients who are easily distracted or overly talkative during a conversation or visit? Any specific ideas for redirection of a patient? I'm trying to think, when I have a patient who's really frustrated or anxious or crying, then one of the common phrase that I'll put in is that patient is extremely tearful. So remember, patients can read exactly everything that we're writing, so we just have to be cautious. I think with that specific example, as I'm thinking about this, I'm thinking about the patient's emotional state. So with that specific example, as I'm thinking through this, I'd write additional information was provided to patient to redirect, to ensure that she verbalizes understanding. Detailed patient education was provided to reinforce original information. Something to the effect of, I have to keep repeating to the patient the same thing because she's not listening to me. I tend to use some of the, like I appreciate your thoughts on that. I'll say, let's circle back to your symptoms. Something that's really going to acknowledge that I heard them, but kind of close that part of the conversation. Or I'll say something like, let's circle back to that later. Right now, I want to focus on this complaint that you came in with. It's hard. It's really hard when you're sitting with a patient and they're kind of going off on a tangent and you're looking at the clock and you're saying, okay, we have to get back to what we're supposed to be talking about because you're also trying to establish that rapport with patients. But I find that if you kind of just acknowledge what they're saying, and then circle back and say, I want to make sure that you leave this office with what you came for. So let's get back to constipation or whatever their issue was. Most people are going to be receptive to that. Not always. Sometimes you just struggle a little bit. Always a balance between trying to listen to the patient and let them talk about their experience, but also redirecting them to use your time efficiently. Right. And I've used that same verbiage as well that Sarah said. You know, I want to make sure you get value from this visit today. So what is the number one symptom that I can help you with? Because I want to provide you with relief. That's after maybe, like you said, Sarah, 10 minutes of them talking and then not being really directive of, okay, I still don't know why you're here. These are great questions. We may take a couple more. Otherwise it is 1030. And so we do have time set aside for a break. If there are any other questions that do come up, please feel free to put those in the Q&A even during the break, and we can try to address them either online later or through typed answers. And if not, we have about 14 minutes. We'll reconvene at 1045 for the next session. Thank you very much. Thank you.

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