Wiki coders allowed to change codes?

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MSCURTISK

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Our office is just beginning to include certified coders.
We are affiliated with local hospital and bill for several physicians,including family practices and variety of specialties.

My question is, as CPCs, is it acceptable that if we find a coding error, that we correct a dx code and/or CPT code?

If not, what is the acceptable procedure for this?

If each correction/error found must be returned to physician for changes, please feel free to share what works for your office to make this as efficient as possible.

Thank you.
My first time posting to the board..forgive me if I forgot any thing!
 
MSCURTISK said:
Our office is just beginning to include certified coders.
We are affiliated with local hospital and bill for several physicians,including family practices and variety of specialties.

My question is, as CPCs, is it acceptable that if we find a coding error, that we correct a dx code and/or CPT code?

If not, what is the acceptable procedure for this?

If each correction/error found must be returned to physician for changes, please feel free to share what works for your office to make this as efficient as possible.

Thank you.
My first time posting to the board..forgive me if I forgot any thing!
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Hello Newbie!

I worked for a Dermatology practice that had 4 physicians, 4 PA's and a general surgeon, kinda sounds like I am about to tell a joke! Haha! Anyway, I was the coder and auditor for my billers, this was my protocol. Remember I had all these physicians to audit before submitting to billing.

I arranged for each biller to obtain the superbill and the dictation, so every morning I had 6 manila files with 20-30 encounters with dictation. I would compare the superbill and dictation, if there were descrepencies within the dication I would set it aside until after the whole file was audited. Say I had 8 encounters with dictation to kick back to the physicians for clarification. I would add a note saying that I need the folder back to me in my hands within 3-4 days. This folder would be placed on their desk at the end of the day by me. I would keep track on a calendar when that folder should come back to me, if I did not receive it, I would have the assigned MA to request the folder be completed and returned to me.

I would give specific detailed to my questions so that there was no back and forth. Once I received that folder back with the updated information I would submit those encounters with the updated dictation or vice-versa to the assigned biller. Sounds tedious but it worked really well for our practice.

Hope this gives you a little advice...good luck!

Denise M. Shoemaker CPC, CPMA
 
Changing dx and cpt codes

Thanks Denise.

I think what you describe is what we currently do,sending back to physician office for ok to correct.

We are offsite from the hospital and there are many offices in the surrounding area that we bill for,so our requests are handled by hospital courier, sometimes by fax if we can do it.

But its time consuming and we are wondering whether we can eliminate any steps from what we already were doing.

What our billing office wanted to know is can the coders automatically correct a code when they see an error (per coding guidelines), as long as we document what we did and why we did it?

I do appreciate your reply, Denise. I will pass along your response to my manager.
Thanks again.

Karin
 
Karin,

First of all, you need a written protocol/policy in place to protect yourself. Second, you need to know if the MDs are being paid according to RVUs. If this is the case (and yes we dislike it intensely!!), they are not going to want to lose RVUs. They will be more than happy to increase their RVUs.

Since our MDs are paid for RVUs, we have to fill out a review/audit sheet and turn them in to the MDs for their review and signature. This is also an educational opportunity to sit with them and show them what is going on with their coding/EMs. Its time consuming but it leaves a paper trail to protect us and we can track trends with them.

We also cannot change dx codes without their approval. That is unless we are adding a 4th or 5th digit. This is also an educational opportunity with them. This is especially true with ICD-10 and higher specificity requirements.

These requirements are VERY cumbersome but we feel protected by them. We do get tired of these restrictions especially when you have one of THOSE MDs who always bill a 4 or 5 because they are speciliasts and we don't want to fight with them all the time. However, it's easier to go to admin and say this is why he/she needs to be on 100% review or why the AR is so high/low.

Good luck!
 
However from a legal standpoint the code is absolutely allowed to change any incorrect code as long they do so according to documentation that clearly supports their choice and according to official coding guidelines
 
We do change codes. We have doctors that still give us consult codes and as everyone knows not all insurances accept them. So in those instances we do change the code. We also have issues with new patient codes being charged for established pts or vice versa. In those instances we also change the codes. Every now and then one of my GI docs will give me the wrong procedure code for a colo or egd and I will change that because my documentation supports what I am billing. Anything else we check with provider but these are the things that we find most often and we change them without checking with the provider. Hope this helps!
 
Hi Karin,

Within those encounters and dictation that I audited, if the note came out to say a level 4 office follow up and the physician billed a level 5. I had permission within my billing dept to change the code where appropriate. I also kept an Excel log of the encounters that I would code differently by physician. Every three months I would pull the report and schedule a one on one E/M meeting to discuss issues with billing, dictation, etc.

On the forefront, we provided continuous education and tools to the physicians on E/M requirements. So when we sit and disuss the report with them it's not like they were in the complete dark on the guidelines. I offered encouragement and support, to the physicians that did not do so well and monitored them a little more than the ones that were doing ok.

But that's the other half on how we handled things..

Have a great day!

Denise
 
thanks everyone for posting.

Some good information. Yes, we have RVUs to consider,and we have met with physicians on that.

What about this situation (just happened to have a discussion at lunch):

Family practice, pt seen had several DX turned in..

do we HAVE TO follow order of encounter/visit slip we receive..

example.. if DEPRESSION listed first but 3 other DX are listed also, and billing Medicare, can we change order of DX or do we have to get written from Dr. /same way?

One of the additional DX listed was SOB...can we switch SOB to primary DX code if done by certified coder?
We've not been taking it upon ourselves to change anything, we do point out errors to our physician offices and they are compliant,
we mostly are curious can we BYPASS some of this, as some of you said, if we see errors in dictation, and have that as backup, can we just make the change (and document it) at our billing office?

Thank you --sorry to be so long winded!

Karin
 
You cannot do anything without benefit of the documentation. You need to see what the reason for the encounter was. You cannot just change the order in order to get paid.
 
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