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Cardiology Coding Alert

Reader Question:

Spot Checks

Published on Sat Sep 01, 2001

Question: Your publication regularly instructs coders to read the entire operative report to make sure the correct codes have been selected. But some of the cardiologists in our practice have requested that I bill without checking that the dictation matches the code that is reported. What should I do?

Idaho Subscriber
 
Answer: There are no mandatory requirements that documentation be created in any particular format or be specifically reviewed before the code is submitted. However, carriers expect the documentation to support the code that is being claimed and, if it doesnt, there could be consequences if an audit is performed.  
 
Obviously, the best way to avoid such problems is for the coder to read every operative report. Doing so also means that every potential charge has been captured. But  not all practices have the resources or desire to read each and every operative report before sending out claims.
 
One solution is for coders to do spot audits to ensure the cardiologists are using the correct codes. Coders are recommended to begin by reading 10 of 10 operative reports and checking them against the codes that were billed. Subsequently, the coder can check 10 of 20, then 10 of 30 and, finally, 10 per month. In this way, coders can be sure that what is billed actually matches the operative reports.

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