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Wiki coder liability

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kbazarte@yahoo.com

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can a coder be held liable for using an incorrect cpt code, my doc wants to always code 32557 even when the catheter is not left in place. I have provided him with education and he insists that he wants 32557 always coded. I am concerned that if there is an audit could I also be held responsible for fraudulent billing
 
Yes, you can be held liable. I would educate the physician again and explain that as a certified coder you are ethically responsible to follow the coding guidelines. Explain why you feel that is not the correct code. Ask him his reasons for "always" wanting to use that code. Physicians are usually not up to date with changes in guidelines and codes. Do it in a learning/teaching way. You have to know when and how to approach the provider. Explain that upcoding is fraud and if the catheter is not left in then it is being coded incorrectly.

If you are that worried about it, then it is probably wrong.

I tell my docs that I am not going to jail with them or for them and that orange clashes with my red hair. I try to keep it light. I am fortunate that my physicians trust my judgement.
 
I have been searching the OIG site to try and find anything in writing that states anyone knowingly submitting incorrect coding can be held liable but could not find anything. Do you by chance know where I can find this. I have provided my doc with alot of education to no evail.
 
thank you so much for providing that. I was planning a meeting with the coding manager but wanted something written I could also provide to support me in refusing to supply the incorrect codes
 
beginner

i have just started is someone interested in getting started with me please reply so that we can begin .
 
rcrouch@crmchealth.org said:
Yes, you can be held liable. I would educate the physician again and explain that as a certified coder you are ethically responsible to follow the coding guidelines. Explain why you feel that is not the correct code. Ask him his reasons for "always" wanting to use that code. Physicians are usually not up to date with changes in guidelines and codes. Do it in a learning/teaching way. You have to know when and how to approach the provider. Explain that upcoding is fraud and if the catheter is not left in then it is being coded incorrectly.

If you are that worried about it, then it is probably wrong.

I tell my docs that I am not going to jail with them or for them and that orange clashes with my red hair. I try to keep it light. I am fortunate that my physicians trust my judgement.
Click to expand...

I have found that if I provide any written documentation that supports my recommendation, it helps.

Excellent advice, Rhonda!
 
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