I have a group of hospitalists who use charge capture management software. I am responsible for making sure that every patient seen is entered into the system, and the physicians are responsible for entering their CPT and ICD9- codes. At discharge, I send a billing file to the biller, who takes care of sending claims electronically to the Carriers and posting payments. I've just been notified that the biller may be using a CPT crosswalk in the following situations:
1. The IP/OP status changed during the admission (Obs/IP) so they (example) change an IP admit code to an Obs admit code.
2. They change a consult code to an established patient code because the Carrier will no longer pay consults.
My question: I'm not comfortable with the biller doing a crosswalk for two reasons:
1. I feel the physician should be educated if using CPT codes that are not consistent with the POS.
2. I feel that it is the responsibility of the Provider to determine their level of care, and I don't want anyone but the Provider determining this.
Are there any CMS guidelines that I can use to support my recommendation that the biller not use the crosswalk, or is this something (using the crosswalk) that the industry supports?
1. The IP/OP status changed during the admission (Obs/IP) so they (example) change an IP admit code to an Obs admit code.
2. They change a consult code to an established patient code because the Carrier will no longer pay consults.
My question: I'm not comfortable with the biller doing a crosswalk for two reasons:
1. I feel the physician should be educated if using CPT codes that are not consistent with the POS.
2. I feel that it is the responsibility of the Provider to determine their level of care, and I don't want anyone but the Provider determining this.
Are there any CMS guidelines that I can use to support my recommendation that the biller not use the crosswalk, or is this something (using the crosswalk) that the industry supports?