Wiki CPC Coding for Physicians or does Physician Code for Themselves

[littlehaskett04]

Can a CPC Code for the Physician or does Physician Code for Themselves

Can someone help clear up some confusion we have in our billing company regarding if a certified coder can code/bill off the inpt hospital records for a phyisician VS if only the physician can code their visit & the coder merely audits it/consults with the doctor if a downcoding/upcoding occurs.
Also, where can I find this information in writting. Whats the exact rule?
Thanks

 

[kevbshields]

I cannot say you will find information or guidelines on this. There is no industry standard, unfortunately.

On the one hand, the provider is responsible for the quality of coding and billing performed on his or her behalf. On the other, a certified coder is the best method of ensuring quality products in that area. Rather than it being a written, explicit protocol, each practice has the ability to choose how it shall run its business, mitigate the risk and deal with the consequences. However, there are several measures to assist the practice in determining the appropriateness of their current approach.

The first would be to consider the rate of denials in this particular area. If the denials, rejections or downcoding rates are high, that indicates the physicians are not properly coding the encounters; remediation is necessary and that is intervention by a certified coder. Secondly, an internal codng quality audit could identify areas where a coder can obtain more compliant or optimized coding than what the physician determined. That is fairly easy to accomplish: take a defined number and set of services currently coded by the providers. Audit those and allow the coder to determine the coding for them, based solely on the record. Compare the samples. If providers are upcoding or downcoding wildly, or have violated ICD-9 coding rules, then a coder is better suited to perform the tasks. If they agree (coder and provider) 95% or greater of the time, then keeping the providers current on the coding quality is the goal.

From a personal opinion, the coder should be abstracting all cases from the health record, but I know not every practice does this.