Wiki code corrections and modifiers

[cwater]

Ultimately the physician is responsible for codes, modifiers and diagnosis that are submitted on a claim.
I am looking for information on what a certified coder can do vs. a non certified medical biller.
Can a medical biller who is not certified add a modifier to a claim or must this be done by a certified coder?
Can a medical biller without certification update information on a claim or must it be a certified coder and what documentation is required to be kept on file?

Any information about the support staff for the provider relating to medical billing in the Pennsylvania regarding what the support person is able to do if they are certified vs. non certified would be appreciated.

Thanks,
Camille Waterhouse, CPC

 

[Chelle-Lynn]

There are no "rules" or "laws" that state that a certified professional coder is the only staff member that can add modifiers, do corrections, etc. As you noted ultimately all coding falls under the responsibility of the billing provider. In some offices this is done by the provider, or they may parcel this out to a coder, or they may parcel this to a clerk/MA/biller/nurse, etc. Each office handles this differently..

It is recommended that your office set a protocol for handling these types of issues in your compliance plan/set-up. It should clearly document each persons role and responsibility in the coding process. Who can set the initial coding? Who can make corrections?

In our office we have clear guidelines in our compliance plan that states what role each staff member has in the documentation and coding process. I would suggest sitting down with your office manager, administrator, or physician and look at setting clear parameters for these office functions.

 

[CatchTheWind]

As long as office policy allows it, any staff member (certified or not) can assign codes, as well as add modifiers, make any necessary corrections to claims, etc. Whatever a certified coder is allowed to do, so can any other staff member - unless office policy states otherwise.

 

[Chelle-Lynn]

Unfortunately there are no rules or laws that require coding being done by a certified coder. Many facilities and offices make it mandatory that the coder be certified but that is up to the provider or office that you are working for.

Obviously if an office is not using a certified coder then they open themselves up to more errors and possible compliance problems.