Justified Billing Practices Can Improve Revenue for Weight-Focused Visits.

OBJECTIVE

To determine whether implementation of a care process for weight management, which included guidance on billing for weight-focused care, changed primary care practice procedure coding and revenue for these visits.

STUDY

DESIGN

PATHWEIGH, a cluster randomized, stepped-wedge pragmatic trial, was conducted across 56 primary care clinics in a single health system.

METHODS

We identified patients receiving weight-focused care by provider use of weight-related diagnostic codes for billing recorded in the electronic health record (EHR). EHR-derived procedure codes for billing were used to examine coding practices for these visits during usual care and intervention phases. Practice revenue for these encounters was calculated based on published mean allowed amounts from paid claims submitted by commercial insurance, Medicare, and Medicaid payers to the Colorado All Payer Claims Database.

RESULTS

Use of 55 unique code combinations was significantly different ( P  < .001) between the usual care and intervention phases. The proportion of weight-focused visits with multiple procedure codes recorded for billing was 14% in the usual care phase vs 19% in the intervention phase, with a shift toward the use of higher-level evaluation and management codes (99214/99215 vs 99213) during the intervention phase. Changes in code combinations resulted in higher mean reimbursements for both initial and subsequent weight-focused visits during the intervention phase compared with usual care. These coding changes increased revenue for the 124,621 weight-focused visits in the intervention phase by $1,071,293.

CONCLUSIONS

Having a care process for weight management in primary care that includes guidance for billing can increase primary care practice revenue for weight-focused care.