6 Key Takeaways from HEALTHCON 2023

AAPC’s 2023 HEALTHCON at the Gaylord Opryland Resort in Nashville, Tennessee brought together coders, billers, auditors, compliance professionals, vendors, and many others.

It was an amazing event with a lot of learning, networking, and social events, too.  Here are some highlights from just one person’s perspective.

Evaluation and Management Panel

One of the general sessions (and annual attendee favorite) is the Evaluation and Management (E/M) panel. The panel included experts from coding and auditing, a physician, and an American Medical Association (AMA) representative.

This year’s panel was especially meaningful because of significant changes to the E/M guidelines that began on January 1, 2023. The major change is similar to those made for some E/M codes in 2021, like selecting the level of code based on medical decision making (MDM) without the history and physical exam contributing to the E/M level chosen. And, of course, selecting an E/M code based on time is also still allowed. But with the new guidelines, the panel of experts addressed many good questions and scenarios. If you are not familiar with the new guidelines, you can review them on the AMA’s website.

Modifier 59 - The Other Misused Modifier

Compliance and coding professionals know that Modifier 59 bypasses some payor edits as outlined in the National Correct Coding Initiative (NCCI). There are times when it is appropriate to use the modifier, but there are also times when it would not be appropriate to use it.

If it is used inappropriately, it could subject providers to overpayments and/or false claims allegations as well as the investigations, frustrations, distractions, payments, and integrity agreements that often go with it. Related modifiers, including XE, XS, XP, and XU, were also discussed. You can learn more about the NCCI and appropriate use of modifiers from the NCCI manual.

The CPT^® Code Set and Digitally Enabled Care

Most of us have experienced the digital evolution of many services we rely on daily. We bank online. We shop online. We educate online. We also participate in healthcare online.

This general session was led by two AMA CPT^® experts who explained how many medical services are becoming more and more available through digital means. With this in mind, the medical coding system also needs to keep pace. Telemedicine and artificial intelligence (AI) were major topics of this session, along with a discussion of the overall coverage and payment landscape for telemedicine. An additional resource to consider is the AMA article titled, “A blueprint for digitally enabled care.”

E/M and Medical Decision Making

As was already mentioned, the new E/M guidelines focus on a physician’s medical decision making. But how does a physician think? And is a coder expected to think like that too?

Several sessions tried to address this question. The “Risky Business -- The Continuity of Risk and Revenue Impact of MDM for EM” session addressed the subjectivity of one of the MDM components: risk. The presenter’s main theme focused on the idea that “a thread of continuity for risk exists throughout all components of MDM.” One of the goals of this session was to help coders and auditors recognize the indicators that impact risk overall and mitigate the subjectivity.

Another session addressing MDM was “Thinking Like an MD for E/M Services.” The goal of this session was to help coders and auditors “see” into the mind of a physician as she processes the information from the patient’s history, physical exam, and diagnostic tests that provide clues for the clinician to reshape her differential diagnosis until arriving at a final diagnosis. Attendees expressed a desire to learn more about how a physician thinks about an encounter so that they can assist their providers in optimal documentation. For those looking for more on this process, check out some of the free videos at www.codermedschool.com.

Networking

One of the best things to do at HEALTHCON is networking with other coding, auditing, and compliance professionals. In-person networking is pretty natural. You sit next to someone you don’t already know in one of the sessions, you ask questions, and share about yourself too. The conference phone app allowed for virtual networking as well. Even those of us who attended in person were utilizing the app to network and schedule meet ups to learn from one another.

Social

The conference was not all work! There was live music, good food, and many opportunities to enjoy all that Nashville has to offer. The welcome session on day one also kicked off the chance to meet with vendors in the exhibit hall. There was a “Codify Happy Hour” at the end of day two. After the day three sessions ended, there was the “Honky-Tonk After-Hours Corral.” All were invited to the Wildhorse Saloon in downtown Nashville for entertainment and dessert. Free shuttle services made it easy to participate.

Conclusion

If you were an attendee, you’ll receive access to the recordings of all the sessions, which is a great opportunity to continue your learning. If you weren’t able to attend, start planning for next year. It will be held in Las Vegas from April 14-17, 2024, and will have virtual options for those who choose not to travel.

To download this blog post as a pdf, click the button below.