The Physician’s Perspective
By David Young, DO
Medical coding isn’t always a precise science, particularly in diagnosis coding, where the ICD-9-CM manual often lags behind medical science. Physicians may know which condition the patient has, but that doesn’t mean a code exists for it. These are the occasions when I often sit down with one of my practice’s coders and we determine a code together. The five physicians in my practice are very open to hearing information from our coders. However, I realize that not every physician makes time for the coding staff.
The following five tips might help coders approach their physicians for information:
1. When you encounter a diagnosis or procedure for which you cannot decide on the precise code, try to narrow down the code choices before approaching the physician. It may be easier for the doctor to look at three or four options and select the right one, rather than leafing through the book trying to find the right section. Another great option is to open the book to the appropriate section and show the physician the descriptions so he or she can see all of the available options. Remember that if you can’t select from the documentation provided, an auditor might have the same problem.
2. If you feel that the physician miscoded a procedure or E/M service, show the physician the guidelines that demonstrate why he or she didn’t meet the service level based on the documentation. For instance, my coder might show me a critical care code that I selected, and then show me my documentation and say, “You only documented two hours of critical care, but you selected the codes that represent two hours and fifteen minutes.” Then she’ll show me the chart in CPT® that shows that I can’t bill my chosen code selection based on the time I documented. Physicians may not like it, but they can’t argue with a coder who shows them AMA’s or insurer documentation in black and white.
3. If the physician tells you about particular acronyms that he or she uses frequently, start a list of those to help you with documentation. For instance, if your physician always writes “A&P” for “auscultation and percussion,” make a note of that so you won’t have to track the doctor down every time you see it. This note should become part of your official documentation policies and procedures, and may be vital should your practice be audited.
4. If all of the physicians in the practice should become aware of a particular coding topic, such as new guidelines, new codes or new documentation rules, call a meeting with the physicians so you only have to go over the information once, rather than having to meet with each physician individually. For example, our coder went over the new bronchoscopy codes with us this year, and that made it easier for us to document those services more accurately. If you recently attended a lecture or read an article about coding a particular service that your physicians frequently perform, let them know what you learned and how this will help the practice code more accurately. One good time to schedule a meeting would be after the new codes come out in the fall, so the coder can review the applicable codes with the physicians.
5. The physicians are best served by having that initial claim go out as clean as possible, rather than having it denied or sent back for more information. Therefore, it’s in the physician’s best interest for you to confirm a code when you’re in doubt rather than shying away from asking.