Wiki E&M Coding??

[kat22875]

E&M level decision making?

I believe it is the Provider's responsibility to choose the level of E&M services he/she provided. Then it is the Coder who should review. We have some Providers that are saying it is the Coders who should choose the level. I am looking for supporting documentation to prove my point. I want to make sure we are in compliance.
Please help!!!!

 

[thomas7331]

E&M level decision making?

I believe it is the Provider's responsibility to choose the level of E&M services he/she provided. Then it is the Coder who should review. We have some Providers that are saying it is the Coders who should choose the level. I am looking for supporting documentation to prove my point. I want to make sure we are in compliance.
Please help!!!!

There's no compliance rule saying that a provider or a coder is responsible for choosing the code or level - the only thing that matters is whether or not the code is supported by documentation, not who coded it. Each organization to decide which approach is best for them: if the providers are able to choose the level accurately and consistently, then there's no real need to hire coders to do it. However, if the provider's don't know the coding rules well and/or don't have the time available to spend learning it and making sure they code correctly, it may be more effective to use the coding staff to do this. There isn't a rule that says it has to be one way or the other.

 

[Orthocoderpgu]

Traditionally providers have not been well educated on E/M coding. For years I saw what E/M levels the doctors were choosing. They were always wrong and based their leveling on what they "felt". I've coded a ton of E/M over the years both IP and OP and multiple specialties. Providers have always over-coded their levels. I once asked a physician why they chose a 99215. Answer: I performed a comprehensive exam. This was before the new 2021 changes. I have never been a fan of providers choosing E/M levels because they have never been educated enough to do so. Physicians understand Pathophysiology, not coding. Why would you ask them to do something that they don't have the educational background to do? Unless a provider can choose their levels based on the actual 2021 guidelines and not their feelings, I would not ask them to do it. Most providers I speak with now don't want to either because they don't want the burden. They want to treat patients and let the coders do their jobs. I agree with that.

 

[bill2doc]

E&M level decision making?

I believe it is the Provider's responsibility to choose the level of E&M services he/she provided. Then it is the Coder who should review. We have some Providers that are saying it is the Coders who should choose the level. I am looking for supporting documentation to prove my point. I want to make sure we are in compliance.
Please help!!!!

The doctors should have the knowledge to code and choose the level. Some doctors don’t even have coders. At the end of the day, if there’s an audit and take backs/refund requests the insurance carrier isn’t going to slap the office coder on the hand, they are going to come straight to the physician. Why would a doctor not want to know the system. If they don’t they could be leaving money on the table.

 

[carlystur]

The doctors should have the knowledge to code and choose the level. Some doctors don’t even have coders. At the end of the day, if there’s an audit and take backs/refund requests the insurance carrier isn’t going to slap the office coder on the hand, they are going to come straight to the physician. Why would a doctor not want to know the system. If they don’t they could be leaving money on the table.

Because they are often not as concerned about leaving money on the table. What they want to do most is treat their patients. I work for a neurosurgery clinic that mostly handles motor vehicle accident or slip and fall cases that our patients have and that is how our doctors feel as we have made them well aware that they are leaving a massive amount of money on the table, but they do not seem very concerned since they are not taking the advice of our workers' comp and billing specialists to be able to get the money that they are owed. As long as the business is still growing with the amount of money still being made, they don't have an issue with making more than they feel they need.