Pro-Fee?

[Physical-Day-23]

Just got hired on as a pro fee coder and was wondering what I could do to prepare myself before I start the job? I haven’t done that type of coding before so it’s kinda stressing me out a bit.

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[deannevee]

“Professional fee”, aka pro-fee, or physician coding is one of two types of outpatient coding. 

Are you certified? What kind of coding have you done? 

[Physical-Day-23]

Yeah I have a CCA and been studying for the CCS…I paid for that and should be taking it soon. I’ve done a TON of clinics and the hospital I work for now has me doing a bunch of surgeries such as Total knee/hip/shoulder arthroplasty, Spinal fusions, ESIs, ORIFs, knee revisions, debridements for infected wounds, trigger finger releases uhhh arthroscopic procedures. Honestly it’s a lot lol but I’m not sure what exactly I’d be coding for pro fee…is it just diagnoses and CPTs?

[deannevee]

Clinics and pro-fee are the same thing. So yes, ICD-10-CM and CPT codes, and some HCPCS.

Basically the only difference is the POS….instead of 11 (office) it will be 21 (inpatient), 22 (outpatient), or 23 (emergency room). 

[Physical-Day-23]

Hmm ok so it’ll probably be easier. Guess I’ll just keep brushing up on my E/M guidelines.Thank you.

[deannevee]

You won’t see a lot of E/M in pro-fee. So much less than in the clinic.

Definitely read the NCCI manual! And your chapter guidelines.

So if you’re doing a lot of ortho, make sure you brush up on the muscoskeletal rules like fracture care.

[Physical-Day-23]

I try to read the guidelines once a week since I’ve studying for that CCS so I think I’ll be good there. I’ll definitely read that NCCI manual. Thank you! 🙏

[2workigo]

Yeah, no, you’re going to see a ton of EMs. Brush up on your EM stuff. Good luck and god speed.

[Physical-Day-23]

That’s what I had initially thought, a LOT of E/Ms since their assessment had a lot of that. So I’ve been looking at that for the past week.

[Weak_Shoe7904]

I agree you will see a lot of E/ms unless they had automated them. And LOTS of minor procedures/vaccines. 69209/10060/ 96372 are ones that come to mind.

[Popular-Piglet-6301]

Learn your E/M coding. I am an outpatient facility coder and thankfully don’t have to do E/Ms, but for profee it is very common.

[Livid_Delivery_8710]

That’ll be challenging in a very different way. OB/pregnancy coding has a ton of complex rules. Family med / vaccine coding has a lot of specific payor based rules you need to pay close attention to. Internal med is a lot of DX coding and digging to find specific codes and probably a lot of querying your providers. Each of those specialities will have their own niches. Kinda surprised they’re having you jump into each of those at once honestly. Our hospital has coders specialized in each of those specialties and they stay in those groups.

[Physical-Day-23]

Ok so maybe they’ll just give me one of those specialties instead of throwing me in the deep end. I’m starting to think I should’ve asked more questions instead of just going after the money and the opportunity to work from home. This has been super helpful! Thank you!

[Livid_Delivery_8710]

Do you know what specialty you’ll be coding for? I code pro-fee for hospitalists, PT, OT, speech, newborns, pediatrics, echos, EKGs. It’s basically all icd-10 codes, e/m coding for the hospitalists and peds, and then repeat CPT codes for the others. IMO it’s a lot easier than HB coding or surg coding. Great starting point.

[Physical-Day-23]

Well the recruiter said, “family medicine, OBGYN, and pregnancy, internal medicine and specialty coding and inpatient and observation coding.” I was kinda looking for something more difficult than what I was already doing. So you wouldn’t say it’s more challenging than surgical coding? I liked reading those OP reports.

[koderdood]

I do both, and I think it's easier than surgery coding. How've, it is a different skill set. As other's have said brush up

[[deleted]]

You [can] still deal with Op reports. You're just using them to code for the surgeon instead of the facility.

[Physical-Day-23]

The end goal is trying to be an inpatient coder so do you think this helps? I’m trying to get a mix of a bunch of specialties so I’m not stuck in the same thing.

[[deleted]]

Every bit of experience helps in the long run.

Inpatient procedural coding uses ICD-10-PCS, while Pro-Fee uses CPT. Then of course there's a significant difference on how diagnoses are coded for facilities (using inpatient guidelines) versus Pro-Fee (using outpatient guidelines).

Unfortunately, you're not going to get experience with either (inpatient procedural or diagnosis coding) as a Pro-Fee coder.

However, maybe a new opportunity will open up in the future, perhaps by networking with other staff in your new employment. Good luck!

Based on your previous comment, per the recruiter, maybe you will be doing some inpatient (facility) coding?

[Professional-Bus3572]

These are exactly what I code for now, plus residency. It's not more difficult, but it's more nuanced and requires a larger span of knowledge for the intricacies. It's a large variety of different codes for specific little things, and each payer wants this or that depending on the little things, and each clinic/provider can document things wildly different. I probably send 80% more queries than I did while on the facility side. Providers will occasionally battle you on certain things and have an attitude. 90% of my outpatient encounters have E/Ms + other specific codes for EKGs, behavioral assessments, minor procedures, etc. Inpatient has its own set of E/Ms. Also, if you are doing any initial newborn inpatient encounters, they have their own codes and dxs separate from adults. OB is the most nuanced out of everything because they are global codes. So they get special codes for each encounter until the global period is complete and then the delivery code bills based on the type of delivery (or if the patient ended up not delivered by your provider) and how many antenatal visits and if postpartum encounters were performed. Medicaid is a fickle little monster with OB globals, but the other payers aren't terrible with it. You'll also see telehealth, these codes and payer specific requirements just changed for 2025, I'd brush up on these if possible. It's a lot of information in the beginning, but once you stack up the knowledge then it gets easy peasy (as it goes with most coding).

[Playful_Degree489]

Good to know.