Wiki Coding Policies/Procedures


Gainesville, VA
Best answers
I work for a hospital system providing physician coding to our hospital-owned physicians. I am interested to discuss with other coders how their employers have set up coding policies and procedures.

Basically this is our current process:

1. Coder recieves charges to review in an EHR workque
2. If any change to the phyisicans code choices need to be made an internal message is sent to the MD to make the change in the EHR and why the change needs to be made.

Then one of 3 things happens:

1. If no response from the MD within 48 hours, the Coder can make the changes based on their review.
2. The MD makes the changes and the claim is released.
3. The MD disagrees with the change and a long drawn out discussion of why and proving why ensues.

The MD's are not required to respond, so most do not and the ones that do usually have a hostile attitude.

Our entire team agrees that it would be more adventageous if we reviewed the charges; made the changes; explained why - and the physicians were not allowed to put up a fight, but were instead required to learn from their mistakes. I'm just interested in finding out if this is the "norm" or does anyone work somewhere where the coder is actually allowed to code and have the final say?
pls help me out

Could you tell me which modifier should I use for Cpt 99406 but insurance paid cpt 99386? Both were in a same super bill.
Physician should respond and make coding choice.

This policy should be the "norm" since the physician bears the ultimate responsibility for the codes being billed.

Suggestion: A coder should be prepared to make a correct coding suggestion to a physician without insulting the physician's intelligence. If the coder is prepared with documentation to prove the policy and/or reason behind the use of the corrected code, the physician can not argue with written proof.
If you can provide the type of insurance that was billed, the date of service, and all the codes billed on the same claim for that DOS, I will offer a suggestion.
BTW... the coder is also responsible for the codes being billed, equal to the physician. There have been numerous past issues of the Coding Edge written on this. In the facility I worked in the physicians did none of the coding the coders provided it all. The only coding summaries created were for the inpatient stays, the provider was required to look those over and sign them, they had so many days to do so, if they had a 30% or more that had not been signed off within that time frame their admitting privileges were suspended.
Oh we do make the coding suggestion to the physician, but mostly they don't respond and we make the changes ourselves anyway. So I kind of think "Whats the point?" They aren't learning anything because they are not required to respond. They ones that choose to argue usually back off after we send them significant proof. We code a significant amount of E/M services so its a difficult area for physicians who have little or no education to understand why their documentation doesn't meet the level of service. And when we have to take the time to explain why, and we get no response - it seems like a failed effort. I just wanted to see how it worked for everyone else.
I would suggest asking the providers if they want to know this information ( ie when a coder changes a LOS) Some may say go ahead and make the necessary changes others want to be involved and want to understand why they did not meet the LOS chosen by them. Our coders discuss with our providers any changes that we make, some want to have the involvment others don't.

It is very crucial that the coder working with the providers understand that they need to protray that they are an ADVOCATE to the provider and not a Adversary (sp?) Coders should work extremely hard a creating a relationship with the providers, I 100% attribute my sucess in coding to doing that.
In our office we do have a superbill and the physicians do mark their code choices on it. Or as close to the code as is on the bill (because of course you can not put all of the ICD-9 codes on one superbill) but ultimately I code the chart from what they dictated about that date of service. Some times their code selection is right but oftentimes the codes are not on the superbill.
And all of our procedures are coded from dictation alone. If I have a question as to what procedure was performed or why a given procedure was performed because the diagnoses listed do not justify what was done, I ask the physician if the procedure code I chose is what he actually performed and if there were any other reasons for why they performed it. If I chose the wrong code they usually point me in the direction of what they believed they did. Then I go back to the note they dictated and make sure that the note supports that code. In the end I choose the code that the note best supports.
I guess I have a great deal of autonomy because I basically choose everything based on what they dictate in their notes.