EMR and Coding Liability

Valenza

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Concord Township, OH
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Is a physician still liable for the CPT and ICD9 code assigned by an EMR's internal coding software system? Let's say that the software has the current CMS regs and CCI edits, and is updated regualrly.

I had a physician state that the EMR vendor told the practice that the company who owns the program (in this case, the vendor) is liable for the codes selected, not the end user, if an external audit revealed a coding issue.
 

RebeccaWoodward*

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I would think that the physician would, ultimatley, be responsible for the outcome of his billing. Technology is a wonderful thing but it can never replace the expertise of the provider. Many products allow the provider to override the level of service (although I don't encourage it). In that case, will the vendor be responsible for the manual change? Probably not. If there was a "coding issue", I imagine that Medicare and other payors will hold the provider responsible not the vendor. It almost sounds (to me) as if the vendor is using this statement as a way to entice the provider to buy into their product.But again...I could be wrong.
 

Lisa Bledsoe

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Greeley, Colorado
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I agree with Rebecca. Whatever goes into the documentation is ultimately the responsibility of the provider. We had to disable our EMR's ICD-9 coding because it was so erroneous! You can't send notes to an insurance for an appeal with a wrong dx in the A/P!!
 

janice.moore

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I also agree with Rebecca. The physician is ultimately responsible for his coding, regardless of whether the computer is choosing it or not. That's why most programs allow for overrides.
 

kevbshields

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Louisville, KY
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There have been a couple articles on this in various trade magazines. Yes, the provider is still liable!

In fact, if that one, simple fact does not add to coders' continued validity in the changing health career landscape, I do not know what else will.

There are providers out there--I'm sure--who are believing what the vendors are telling them about EMR software and its coding element. However, we'll just wait and see which one of them gets fleeced of his retirement first (from defrauding the government) . . .

Keep up the "good fight", coders!
 
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