Wiki Dealing with a Provider who questions your ability?

dcrossman

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I'm hoping someone can offer me some advice.
We have just added a new Doctor to our office. I have been working in this office for 2 years doing their billing and coding. I'm a CPC and have been coding for about 7 years.

This new doctor hasn't come right out and said he doesn't think I know what I'm doing, but I feel like I'm being grilled every time I talk to him. I'm wondering what I should do, or if anyone has advice for me? :confused:

At first I thought if I showed him how I work through a code it may set his mind at ease, so I showed him how I take the information from his note and superbill and translate that into the codes, even showing him the ICD-9 book so he could see exactly what it said. That appeared to work, until the next day when I went to him for clarification on a code and he basically told me that the code didn't need to be that specific. Last time I checked it was drilled into us to code to the highest level of specificity. I'm in OB/GYN so "blood disorder" wasn't really enough for me. When I went to ask what disorder she had, he told me there wasn't a code that would be more specific than that. Apparently at one time he owned his own practice and he speakes "ICD-9-ese". I'm confident he doesn't know much about coding. Just enough to get him in trouble. Turns out she had Factor II deficiency, and Factor V was negative. He charted she had Factor V.

I've explained "code what you know, not what you suspect" but that doesn't seem to be registering either. I've gone to my boss, and she and I both sat down with the owner/ head Doctor, but I'm left with this feeling of defensiveness and dread every time I need to clarify a code with him. Has anyone else gone through this, and does anyone have any advice? I'm hoping I'm not the only one out there that this has happened to. I guess I'm just looking for reassurance.

Devon Crossman
CPC, Bangor Maine
 
At some point or another I think we all deal with someone like this. I've found that explaining the coding guidelines and my role as a coder and auditor helps. If they understand that we cannot assume anything about what they've written and that we are not clinicians they understand that. Then I explain the "coding world" so they understand what specificity is and why more information is sometimes needed. Drilling it down this simple tends to help. That and lots of patience.

If this is a new physician to the group...he's probably also feeling stress and feeling like he has to prove himself. If his previous office (if he had one) didn't have a certified coder or didn't have a coder that asked questions or really cared, that could be part of it too, the unfamiliarity.

Perhaps having a meeting with your supervisor and this doctor and approach it from the "help me to help you" perspective where you ask what you can do to help explain coding and documentation better so that he can help you do your job better...might work???
 
I have the same issue with a few of my doctors, but my plastic surgeon is the worse. She treats me like I don't know what I am doing too and wants to unbundle everything she does.

I have found that before I go to her to show her how to code something that I need to have everything in order and all of my documentation to support my choices ready at hand. Then she can't question what codes are what! This is frustrating as it takes me at least twice as long to code her surgeries as I have to make sure all of my choices have supporting documentation, but it does stop her from fighting me. Although, she weill still try to get a different answer from someone else to support her, but that usually gets her no where!

So, my suggestion is to start collecting supporting documentation for anything you are being questioned on - then they have no reason to question your decisions!
 
difficult???!!!!!

I've had this situation in the past with a new hand surgeon. He had the "white coat: thing goin' on. He would come into the office and actually say how were you trained blah blah. When I started asking him if he felt his documentation could be supported by an outside audit he backed down. He did get to trust my judgement.

There is always the aspect of correct coding may actually get you paid appropriately for the service performed.

Then, you can always indicate that intentional misinformation by misleading dx., under/over coding could be construed as Abusive or Fraudulent billing. This would then cause claims to be slowed down by flags at the insurance companies and the medical records to come under scrutiny. That in turn could bring down allot of stuff they really don't want to deal with.
 
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