Wiki Accurate coding

[lfinns]

I work for a Health Department and many of our clients are cash pay and on a sliding scale. Do you think these claims should have correct coding, procedure codes and dx codes, even though 3rd parties are not billed? I was told that since we are not billing, it is not necessary to have all the dx codes.

 

[mitchellde]

Yes I believe accurate and complete coding is always necessary and it is the responsibility of the coder to provide this for every encounter regardless of the patient insurance or ability to pay.

 

[thomas7331]

If no claim is going out, you don't have to worry about a false claim, but that doesn't mean you shouldn't code the patient's account as accurately as you would any other. In my experience patient accounts can end up being billed somewhere at a later date, such as if the patient receives a retro-active coverage of some kind, so it's still important to have everything correct. Also, your employer may need to report their data internally or to an outside agency, so may be relying on you to code the accounts accurately even if they aren't billed to insurance. Your employer really should be the one to give you guidance on this, but in the absence of any specific policy in place, I would recommend you code all of your cash pay accounts as you would those billed to insurance.

 

[Pathos]

I agree with Thomas and Debra. Sounds like you work for some type of governmental office, which should always require Correct Coding anytime medical services are provided and billed, whether or not insurance is involved.

Think of this as all patients are Self-Pay? This would not only be best practices, but would help explain why you billed XYZ services to the patient.