23023
Dave Durham CPC
Objective:
Smart Technically Savvy Medical Records Coder
EM encounter analyzation:
• CC (Chief Complaint)
• HPI (History of Present Illness — can pull dx from HPI)
• PFSH (Past/Family/Social History — required in NP/ not necessarily in est pt.)
• ROS (Review of Systems)
• Exam (PF/EPF/Detailed/comp — determined by number of body systems examined)
• Impression/Plan (Dx and MDM determination)
• equates to obtain appropriate level of EM
Optimal Specialty Coding Skills
*** • EM Physician office coding
*** • EM Facility coding
*** • EM Family Practice coding
*** • Outpatient facility coding
*** • Internal Medicine
*** • EM 95/97 guidelines
*** • CPT coding
*** • HCPCS coding
*** • ICD-10-CM &PCS coding
** • EPIC Charge Master Coding Claim/Denial edits
** • Optum 360/ 3M encoder Pro
*** • EPIC EMR and Coding Processes*** • Windows 10
*** • Microsoft Office 2016
*** • Microsoft Skype
*** • Microsoft Cortana
*** • Microsoft Mixed Reality
*** • Microsoft Teams
*** • Apple IPAD medical coding apps (3M HCA, PT 2017, OptumCare, etc.)
*** • Apple AirPlay
Experience
Remote Multispecialty Medical Coder II Baylor, Scott, and White Healthcare July 2019 – August 2019
• Coding selected EPIC coding queues
• Utilizing 3M Encoder/NThrive applications to obtain CCI edits and RVU values for sequencing purposes, LCDs, modifier usage, etc.
• Appropriate use and insertion of modifiers (25, 24, 26, 59, 51, LT, RT, 50, etc.).
• Pro fee coding of E/M visits, new patient E/M visits in coordination with injection procedures (25 modifier), joint injections (20600–20610), Preventive visits (99381–97), and Annual Well Visits (G0402, G0438-9), etc.
• Teaching resident physician coding using GC modifier (attending physician examining patient with resident) and GE modifier (resident servicing the patient with attending physician review).
• Coding of encounters for sports physicals (MS00145) and administrative visits.
• Split level coding for EM and already charged preventive, AWV, and office procedures.
• Researched and identified areas for additional coding revenue
• Collaborate with internal staff through coding queries to ensure appropriate coding protocol is followed by corporate coding protocol standards for EM coding levels and any necessarily medical record amendments.
• Enter coding information into EPIC charge master using medical coding protocol to submit a statement or claim.
Pro Fee and Outpatient Medical Coder Mednax August 2018 – March 2019
• Coding selected facility batches (queues) for selected DOS
• Utilizing Optum 360 Encoder Pro to obtain CCI edits and RVU values for sequencing purposes, LCDs, modifier usage, etc.
• Appropriate use and insertion of modifiers (25, 26, 59, 51, etc.)
• Pain Management coding of E/M visits, new patient E/M visits in coordination with injection procedures (25modifier), joint injections (20600–20610), nerve blocks, sacroiliac joint injections (27096), etc.
• CPT Facility Surgical Coding of Spinal Cord Stimulator placements and trials (63650 – 85)
• Moderate Sedation (99152-99155) in association with Procedural codes
• Accessing EPIC EMR to acquire appropriate encounter notes for selected DOS batch
• Researched and identified areas for additional coding revenue
• Collaborate with internal staff to ensure appropriate coding procedures are taken in response to inquiries, questions or concerns
• Enter coding information into the corporate billing system (Medsuite) using medical coding protocol to produce a statement or claim
EM and Outpatient Medical Coder Raleigh Ophthalmology May 2017 – Aug 2018
• Coding and billing work controls (queues) for each physician
• Ophthalmology EM coding 99201-99214 services and E/M in coordination with procedures (25/57 modifier), 92015 Refraction services,
• Ophthalmology Outpatient coding of 66982-66984 optical cataract surgical coding, 15821-23 Bleph Sx, 65855 Laser Trabeculoplasty procedures, 66761 Laser Iridotomy, 92082, 92083 Visual field intermediate and complex exams, 67101and 67105 Retinal repair, 92225 and 92226 Ophthalmoscopy, 67101 and 67105 Retinal repair, 66821 YAG Laser, etc.
• Coding of CPT Category III for new procedures
• Advises physicians on more precise documentation amendments to patient’s encounter notes, exams, and procedures notes within the EMR
• Researched and identified areas for additional coding revenue
• Collaborate with internal staff to ensure appropriate coding procedures are taken in response to inquiries, questions or concerns
• Enter coding information into the facility Billing system (Key Med) using medical coding protocol to produce a statement or claim
Physical and Outpatient Therapy Medical Coder Account Temps (Legacy Healthcare) March 2017 – May 2017
• Coding charges for physical therapy (97161-97164), Occupational therapy (97165-97168), athletic training (97169- 97172)
• Conducts timely and effective research on collection of claims submitted
• Research denials and initiates appeals as needed
• Work with payer representatives to find solutions to coding and other denials
• Researched and identified areas for additional coding revenue
• Collaborate with patients, insurance carriers, and internal staff to ensure appropriate procedures are taken in response to inquiries, questions or concerns
• Enter coding information into the facility Billing system (Medisoft application) using medical coding protocol to produce a statement or claim
• Submit claims to appropriate payors
Outpatient DME Medical Coder UNC Rex Healthcare April 2014 – March 2017
• Coding and billing of work controls (queues) for each physician
• DME coding of crutches (A4635 – 37/E0100 – 117), Walkers (E0130-E0159), bathroom equipment (E0163-68, E0240 -248), DECUBITUS CARE EQUIPMENT (A4640, E0181 -E0373), Hospital Beds (E0271-E0329), Trapeze equipment (E0840 -948), Oxygen (A4556-66/A4604-20/A7020-39), Wheel chairs (E1230/K0800 – K0812/E1031/E1161/K0001-09), and infusion (+ A4230-32/E0776-80/K0455-0605)
• Advises physicians on more precise documentation amendments to patient’s encounter notes, exams, and procedures notes within the EMR
• Researched and identified areas for additional coding revenue
• Collaborate with internal staff to ensure appropriate coding procedures are taken in response to inquiries, questions or concerns
• Enter coding information into the facility Billing system (Key Med) using medical coding protocol to produce a statement or claim
Dave’s Linked In portfolio
Education
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Pfeiffer University08/2015MHA
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Masters of Health Administration (Currently pursuing)
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Pfeiffer University08/2015MBA
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Masters of Business Administration (currently Pursuing)
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Virginia Western Community College01/2012 - 07/2013Certificate
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Health Records Coding Certificate
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Virginia Western Community College01/2012 - 07/2013Certificate
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Medical Office Specialist Certificate
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Radford University08/1998 - 12/2001Bachelors of Science
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Bachelors of Science in Economics
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Contact Candidate
To contact this candidate email Dave6032@outlook.com