The following information contains detailed descriptions for the metrics available in the Services category of the Pulse module.
99214 / 99213 Ratio
The 99214/99213 Ratio metric compares the number of encounters coded with 99214 to the number of encounters coded with 99213. Watch the trends of these codes to highlight changes in the types of patients and types of visits. This metric comparison also helps identify potential under coding of encounters where documentation would have justified a higher CPT code. Note: Always utilize proper documentation and coding standards for appropriate billing.
- The data displayed is the number of encounters coded with 99214 versus number of encounters coded with 99213.
- All non-canceled encounters are included in this metric.
- The numerator is equal to the number of encounters that contain 99214 in the Performed Services tab of the Coding screen.
- The denominator is equal to the number of encounters that contain 99213 in the Performed Services tab of the Coding screen.
- If a practice has encounters that are not associated with a provider, "No Provider Assigned" displays within the graph.
Medical Management
Practices that are focused on providing primary eye care should have a consistent level of medical codes billed to encounters. This trend may indicate changes in the types of patients seen, which can help with decisions about insurance and equipment.
- The data displayed is the number of encounters with a medical diagnosis associated to 92xxx or 99xxx, divided by, the number of encounters coded with 92xxx, 99xxx, S0620, or S0621.
- CPT codes and diagnoses are assigned in the Performed Services tab of the Coding screen.
- If a practice has encounters that are not associated with a provider, "No Provider Assigned" displays within the graph.
- Numerator:
- Number of non-canceled encounters with a medical diagnosis assigned to either a 92xxx or 99xxx code.
- If the encounter has both a medical and refractive diagnosis assigned to the service code, it will be included.
- Denominator:
- Non-canceled encounters that have a CPT code of either 92xxx,99xxx, S0620, or S0621 listed in the Coding screen of the encounter.