Coders & Providers: Let’s All Get Along
Take the correct course of action to find conflict resolution.
By Shreka D. Rogers, CPC, CMRS, CMSCS
Count how many times this scenario has played out in your office: Dr. X wants to report a service a certain way, but you believe the service should be reported differently. It probably happens too often. To help you determine the best course of action when this sort of thing happens at your office, consider the following examples:
Example No. 1: Dr. X decides to report 36221 Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed and moderate sedation (99143-99150). The physician’s argument is, if sedation was performed, he should report it. The coder’s argument is, per CPT® guidelines, conscious sedation is included or bundled into the service. The physician disagrees with CPT® regarding this issue, and decides the service should be reported.
Example No. 2: A provider would like to report a microscopic dissection (+69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)) with 31561 Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope. CPT® clearly states that it’s inappropriate to report these two codes together because the microsurgical techniques are included with the service. The provider insists on reporting both codes.
What Should You Do?
Kindly remind the physician about the consequences of incorrect coding. Reminders of this nature can often change a provider’s mind. For some physicians, declining reimbursement has been an enticement to inaccurate coding. If doing the right thing is not enough to change your physician’s mind, the mention of civil penalties, monetary damages, and jail time can be compelling.
Do Your Job—Be Compliant
Most physicians depend on their coding staff to keep abreast of coding changes and reimbursement challenges. Providers also do well to remain well informed of those changes. Providers should remember when a code is reported to an insurance carrier to represent a service that was performed, the name that appears on the claims is the provider’s, not the coder’s. This does not absolve coders of their responsibility to accurately report services. As Certified Professional Coders (CPCs®), you have a Code of Ethics to which you must adhere.
Research and Discuss
Arriving at common ground can require lengthy discussions between providers and coders, as well as a great deal of research. The additional work involved in arriving at accurate reporting will be well worth the effort. As well, this supple-mentary work can foster an incomparable level of professional confidence among providers and coders.
Shreka D. Rogers, CPC, CMRS, CMSCS, has more than 19 years of healthcare experience. She is business and coding manager of Howell Allen Clinic and Saint Thomas Outpatient Neurosurgical Center, where she oversees a staff of diligent coders, as well as skilled medical records and patient accounting teams. Rogers was 2009 president of the local AAPC chapter in Nashville, Tenn. Visit her website at www.realworldbiller.com.