Coders choosing e/m codes instead of MD's

Capemom

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My practice is considering having the coders determine and choose the coding versus having the physicians code and then be audited. I was wondering if there is anyone else out there in this situation and if so what happens in the event of an audit? Who is held responsible? Coders, physician, or both?
 

em2177

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In our office the physician documents the E/M level. We are not allowed to modify it unless we are asked to review the note and give recommendations.....:(
 

mitchellde

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Even if the provider selects the code the coder is still equally responsible for it since you are to review the record prior to creating the claim. To me it is more efficient to let the coders do all the coding.
 
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I agree with Debra. Most physicians do not know coding rules. The 18 physicians in our practices do a preliminary code--As a nurse, certified auditor and coder, I'am frequently changing their codes and attempting to educate them. (Counting ROS elments (etc) is not a MD priority.) If a coder does not have the medical perpspective to judge severity/risk they need to communicate with the physican on that case. Since I'm not a physician, unless the MDM is really clear cut --I will let them have the benefit of the doubt with the MDM. However, you have to stand up to them--if the required elements are not documented--it doesn't fit the code period. After 30 years of nursing, I'm not going down for assisting fraudulent behavior by agreeing that every patient Dr. X touches is a level 5, just because he says so!

Maryann Fisher, RN, MS, CPC, CPC-H, CEMC, CPMA, CPCO
 

mcandia

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Although you would be billing based on abstraction vs. provider assignment of the E/M level both parties share some level of responsibility / accountability.

It is the coder / auditors responsibility to assign the correct level of service based upon the provider's supporting documentation. It can negatively impact the provider of service if not done accurately.

Regardless, it is also the provider's ultimate responsibility to ensure that all professional services billed in their name are accurately reflected in the record.


Maria CPC, CPC-H, CPCO, CPMA, CEMC
 

jimbo1231

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Responsibility

Strictly from a legal perspective, the provider is held ultimately responsible for documentation and coding. The bulk of government litigation has been against the provider not the biller/coder. Although there has been some litigation involving the coder/biller.Especially outsourced entities that have habitually upcoded and not followed guidelines.
But I agree that it is almost always the better choice for physician practices to allow certified coders whether employees or outsourced to do the coding. I have found over the years maybe 1 out of 5 docs have the temperment, time or interst to learn coding. And some of the docs who have actually learned coding have become coding consultants!

Jim
 
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