Wiki Bill with or without op note???

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yem5173

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I have asked the AAPC for their opinion on this and was told they can not give me an answer. Is it ethical to bill for a procedure without the operative note? My boss is telling me that the doctor takes all liability b/c they are coding the services while I am just entering the charge to the software to be submitted to the insurance carrier. I want to hold up the billing so I can verify what the doctor bills. The boss says no, bill it via the codes given per MD w/o op note. I feel that is against our ethical code as CPC's. But she wants documentation or she will force me to bill or she will terminate my job. If anyone has any info, it would be helpful. I tried to look for what is required to bill but can not find a straight answer.
 
What is your job?

If they are using you as a data entry clerk then I see no ethical issue at all. Unless you know they are billing for things that aren't done, then it wouldn't matter if you were a coder or not, it would be unethical for anyone to allow that to go on.

On the other hand if they are saying everything is checked and verified by a CPC before it is billed for compliance reasons, then that would be a huge issue in my opinion.

Laura, CPC
 
I am a CPC. I am their coding/audit coord. I am doing some data entry by posting the charges. The doctor is billing them from their blackberries on the same day as procedure. But I am expected to send them out the next day without verification of any kind. I truely believe that is unethical. My boss checked with the AGA and they said that I can bill that way. But I am still leary on it. I need to get some type of answer or my job will be terminated.
 
I don't know that you'll find it in writing that it is required to have the op note in order to post the surgical charges. In my opinion, those charges are really no different than those that your front office staff posts'. With that being said....I do agree that you should have access to the operative note. It would be in their best interest for you to read the op note to ensure you are capturing all revenue or detect coding/documentation discrepensies. If you feel that there is a possibility of incorrect reporting of charges or services that are billed that aren't provided, I would encourage you to read section 4.2.1

http://www.cms.hhs.gov/manuals/downloads/pim83c04.pdf
 
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