Does EMR use make upcoding more likely?

An intriguing article on the KevinMD blog (http://www.kevinmd.com/blog/2009/04/how-electronic-medical-records-can-lead.html) suggests that EMR use -- which can involve cutting and pasting old text into templates -- is ultimately leading to upcoding.

He notes that in one case, auditors found that three different EMRs tended to upcode visits as 99214s and 99215s. This resulted in some huge fines for physicians, as much as $175K in one case.

Do you see this happening in your practice? If not, how do you protect against this problem?

re: Does EMR use make upcoding more likely?

Not in mine; I document what I do. If I don't ask it, I don't click it. If I use a template as with normal Physicals, I know I examined all the parts that are listed.

I reject the premise- EMR's do not upcode. Doctors use EMR's as a tool for upcoding.

re: Does EMR use make upcoding more likely?

I hate to admit this, but I've come to dread auditing EMR notes.

There are some groups and clinicians who, like signaturedoc, only document what was done. But, there is so much copying and pasting, so many "normal ROS" and "normal exams" that populate volumes of data and provide not much information. I am constantly making judgments about whether to count that ROS or exam.

When the HPI/ROS contradict one another: what do I audit?
When the exam is exactly the same for all ten notes: what do I say?
When the subsequent hospital visit is 98% the same from day to day, what do I credit?

Honestly, the value of these notes..... Often I question whether a covering partner could tell what happened at the visit.

Admitting this makes me look like a luddite.

re: Does EMR use make upcoding more likely?

You are not a Luddite.

The EMR has become a tool to allow doctors to get paid what they "deserve" to get paid. We hate counting bullet points, we hate having to document a comprehensive ROS on a patient with an acute MI to get paid a high level H&P (does it really matter if they have nocturia or a funny mole?) so the EMR lets us click to get to that magic number of systems.

When we did not have EMR's these docs wrote "full ROS performed and negative."

The motto is that if you did not document it, you did not do it. So why is the converse not true? If I document it, then I did it. If the insurer is calling me a liar, so be it. But then again if what I document clearly contradicts something else, then I am on my own to defend that.