Wiki Do you try to correct codes that are wrong?

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shelle28

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Recent scenario I have come across. I had a chart where the provider coded patient as having E08.40 which is diabetes mellitus caused by an underlying condition and unspecified diabetic neuropathy. ICD 10 says you have to code the underlying condition first. When I looked through patient's previous visits, I seen the same code being used, but I found no underlying condition listed. I queried the provider about it, and she responded with deleting E08.40 and adding E11.65 and E10.43 🤦‍♀️ I asked another coder I work with about it and her response was "well that's what has been coded previously". Am I wrong for trying to fix this? I feel like I'm being told "well that's what was coded previously so just code it and move on" and I don't want to do that. I want to do it the right way. I didn't see anywhere in patient's record where they were diagnosed with type 1 diabetes (patient is 75 years old). If this provider is just trying to say that the patient has type 2 diabetes with diabetic neuropathy then that's what should be coded. Instead, now I've got the provider saying the patient has type 2 and type1 diabetes and I don't know if I should message the provider back again (and piss her off) and ask her if those two codes are what she meant to use. Just looking for feedback.
 
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I assign the correct diagnosis codes based on what the provider has descriptively documented in the charts.

I don't even look at the diagnosis code that happens to pull over on the provider record. The diagnostic statement is the provider's area of expertise.

My area of expertise is assigning the proper diagnosis code according to coding guidelines. To be honest, I wish that it wasn't even a feature of EMRs to pull a code over on the provider's documentation. Just pull the verbal diagnostic statement and let coders assign the correct code.
 
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There is a code for patients having both Type II and I.... (Type 1.5...look it up).

I guess I am confused as to why if you are working as a coder you wouldn't be expected to code correctly. Is the provider giving you an ICD-10-CM code, or are you coding based on his note language? Either way, you should report the condition based on the language, not the provider's random choice of an ICD-10 code. Maybe someone should bring this to your provider's attention....incorrect coding can be problematic with unpaid claims or reporting conditions that the patient doesn't have. There's nothing worse than an unhappy patient who has had a claim incorrectly coded--- potential accusations of fraudulent billing (particularly with Medicare).
 
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Pam Warren said:
There is a code for patients having both Type II and I.... (Type 1.5...look it up).

I guess I am confused as to why if you are working as a coder you wouldn't be expected to code correctly. Is the provider giving you an ICD-10-CM code, or are you coding based on his note language? Either way, you should report the condition based on the language, not the provider's random choice of an ICD-10 code. Maybe someone should bring this to your provider's attention....incorrect coding can be problematic with unpaid claims or reporting conditions that the patient doesn't have. There's nothing worse than an unhappy patient who has had a claim incorrectly coded--- potential accusations of fraudulent billing (particularly with Medicare).
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The provider gave me the E08.42 code so I queried the provider about providing the underlying condition so that could be coded as well.
 
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First, I think it depends on what you are being asked to do as far as duties with coding. Are you just tasked with pushing claims out and not trying to correct anything? Does your group have the stance that you must just do what the provider lists and nothing else? If that is the case, I don't know why they would even employ a coder. I have encountered situations where I was not allowed to change anything. Why was I even there then?
If your duty is to actually do what we are trained to do and code correctly from the chart:
What are the WORDS of the diagnosis in the chart. Like suggested above, you code from the words in the documentation not just ICD-10s that may or may not be carried over or incorrectly chosen by the provider.
So, tell us what do the words say? That is what you would code. Ignore the ICD-10 codes they are spitting out to you, what does the note say? If it is still unclear, then query again or if pushback, do you have a senior, lead or supervisor you can go to if you are not comfortable just "moving" on?
 
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