Wiki EHR Claim Corrections


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I could use some outside advice on how to handle corrected claims. We use an EHR so the progress note gets coded and when the claim is created, it's a "snapshot in time" ... it pulls the coding from the chart and makes the claim. When a claim is denied, it's easy enough to correct the claim and resubmit. However this only corrects the claim -- the "chart" still contains the original coding. Because of this, we go the extra step of having the provider unlock the chart and correct it as well. When I ask my obligatory CPC-A question of "why" ... the answer is because of concerns that an auditor would see a discrepancy between the chart and the claim. My concern is that we may be doing extra work that's not necessary.

Here's a typical example. A pediatric Well Visit with Z00.129 gets denied because the patient is 10 days old. We have just one payer that wants Z00.111. No problem, correct the claim and re-send. But the patient's progress note would still show Z00.129 unless we go the extra step to have the provider unlock the chart and correct it.

In your opinion, is the extra work necessary and/or prudent? It seems to me that this is unique to EHRs since a paper chart would most likely not have an actual diagnosis or CPT code in the progress note. Any advice is appreciated. Thanks!