As Good as Your Word: Tips for Better Communication
By Susan Ward, CPC, CPC-H
I left the AAPC National Conference in Seattle last April completely invigorated about my coding career and filled with knowledge gleaned from the breakout sessions. On the plane going home, the woman sitting next to me asked why I was in Seattle. I told her that I was at the AAPC conference. Her eyes lit up. “You do coding?” she asked.
She excitedly questioned me about coding and reimbursement and, as our conversation continued, I learned that she was a psychiatrist and was having coding and billing issues. She did not realize, as I have found with many physicians, that downcoding is just as much an issue as upcoding, and that downcoding can bring upon an audit situation just as easily as upcoding. She was quite interested in the possibility of downcoding being a true issue, but I was able to communicate to her the reasoning behind why downcoding her patient visits could “raise flags” with the carriers.
This experience made me realize how we all have different styles of how to give and receive information — perhaps this physician’s coder wasn’t comfortable giving her coding information. Perhaps I may not have been as open with a physician who appeared uninterested in coding information. As professionals in the coding industry, it is helpful for us to be aware of the communication style of the physician with whom we are sharing information, since this helps them hear the important information we have for them. Let’s look at a couple of “issues” and the different ways we can communicate in each instance.
Issue 1: The physician who wants assistance
Coders often find errors in the documentation of time regarding critical care services. Suppose a physician asks you to meet with him because you were forced to downcode his visit to a hospital visit when the physician feels that he has provided critical care services. This is a wonderful teaching opportunity for us as coders because the provider is asking for your help — he wants an understanding of the criteria you need in the documentation. In this situation, all you need is a copy of the documentation in question and the guidelines as published in the CPT® codebook. Show the physician what he has done right in the past — positive reinforcement is always helpful in any situation. Then give the provider a copy of the guidelines and review them with him, and then bring out the document in question. Once the guidelines are understood, reviewing the documentation becomes a moot point in some cases.
I usually can get a chuckle out of the physician as he sees the error of his ways. During this meeting, the physician and I are treating each other with respect as individuals who have knowledge and understanding in their areas of expertise. Neither of us has spoken down to each other or treated each other any less than the way we want to be treated ourselves.
Issue 2: The physician is angry that you downcoded his visit
The above example was easy … the provider wanted help and you were more than willing to work with him. Now let’s turn the tables.
The provider that you must meet with keeps yelling at you for downcoding his visits. It’s hard to get his attention focused because he demands to meet with you to show you what you have done wrong. We’ll use the same scenario as above (downcoded critical care), but this physician does not take anything you say seriously. You are “just” the coder; he is the doctor. His attitude is, “I went to medical school and can save lives … what does a coder know … she is just a glorified data entry person.”
Thankfully, not many physicians think this way. But when there’s a communication barrier, it is your job to break it down and communicate with your physician in a way that does not demean the physician. However, breaking down these barriers isn’t easy.
With this provider already on the defensive, I would suggest writing everything down with proof of documented guidelines for your presentation. Pull your resources together from periodicals that the physician respects. Sometimes showing your physician what you have done to obtain your education and credentials can help. Demonstrate the utmost respect for the physician’s clinical abilities. Remember that your role is to protect him from any possible abusive situation in his coding. Both parties must be open to giving and receiving necessary information.
Unfortunately, we aren’t always lucky to have physicians who take the time to understand coding and billing issues. If we were, there wouldn’t be a need for OIG to conduct investigations for abuse in the coding and billing field. I have always taught my providers to have a certified coder working for them to avoid any improprieties that could affect their practice. Even if your physician intimidates you, it is better to ask him a follow-up question than to guess a code selection. If necessary, leave a note on your physician’s desk requesting time to clarify some documentation. Make a copy of the documentation in question, put it on the physician’s desk and ask him to review it for clarification and to return his response to you. For example: “Dr. X, I just received this pathology report. I looked up the terminology that the pathologist used and I am still confused as to what the pathologist is saying here. Can you please explain his findings to me so I can find the appropriate diagnostic code?”
Communication means “to make common” or “to share.” We, as coders, are sharing our knowledge with our providers.