Coder coding for E/M instead of Physicians


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I have been asked if I would take on some hospitalist. They would like for me to pull up their documentation and code the level of E/M code for them. I seem to remember something said in school how coders can only Audit E/M codes not code them. Is there some rule against coders coding for the physician E/M codes?

Thank you.


True Blue
Local Chapter Officer
Modesto, CA
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A coder can level a claim and assign CPT Codes (E&M) at the discretion of the provider. There is no "rule" or "law" prohibiting this service. Coders can code and/or level any claim based on the agreement with the provider. The provider is ultimately responsible for all coding under their license.

The medical provider controls the documentation describingwhat services were actually provided and this documentation serves as the basisfor bills sent to patients and insurers. State and Federal laws require that claimssubmitted to insurers certify that the services were actually rendered; weremedically necessary; and, were performed by qualified individuals. By signingand submitting the claim, both the individual medical provider and the billingorganization are attesting that information on the claim is supported bydocumentation and is accurate.

Coding is the act of translating the information enteredwithin the medical record, by the medical provider and ancillary personnel,into code sets. These code sets include Evaluation and Management codes (CPT),Procedure codes (CPT), and Diagnostic (ICD-10) codes.
While any of these code sets may be determined by otherqualified personnel, any code specified by the medical provider may not bechanged without the approval by that provider.

CPT E&M coding:
The individual assigned theresponsibility of selecting the correct level of E&M service documented bythe medical provider must be knowledgeable in medical terminology, humananatomy, and understand the concept of how the levels are determined.

CPT Procedure coding:
Individuals assigned the responsibility ofdetermining the correct Procedure code supported by the documentation must beknowledgeable in medical terminology, human anatomy, clinical procedures, appropriatelaws and regulations, and, in-depth knowledge in the use of the current yearCPT and HCPCS manuals.

Diagnostic Coding:
Individuals assigned the responsibilityof determining the correct Diagnostic code(s) supported by the documentationmust be knowledgeable in medical terminology, human anatomy, clinicaldiagnosis, ICD-10 coding concepts, and, in-depth knowledge in the use of thecurrent year ICD-10-CM manual.

While other personnel may be trained to responsiblytranslate chart documentation into one or more of these code sets, the medicalprovider retains the responsibility for the accuracy and completeness of theassigned codes. By his/her signature on the claim, the medical provider iscertifying that the payment requested by the claim has been earned.