Wiki Help!

[kbarron]

As a CPC with 15 yrs exp in coding and billing, what is allowable by right of my license. We get superbills that have eg: wrong code for age, wrong procedure codes circled,procedures missing per soap note, etc. What are we allowed to do? Does each charge that is wrong need to be sent to the provider, have superbill redone and a letter from provider explaning why the code is being changed in case we have an audit situation? Can the superbill be corrected by the CPC with their initials explaining the reason for the change and a brief note to Provider stating reason for change? I am getting mixed messages. Thanks for any help...

 

[ajs]

There are not really any "rights'" based on your certification. What you do have is common sense for correcting minor errors. If the wrong Preventive E/M was circled due to the patient's age, correct it. That does not change what happened in the visit, it is a minor correction.

Whether or not to make corrections on missing procedure codes depends on what they are. If you see in a note they gave an injection but it wasn't circled, then circle it. Or if there is a test that was done, like urinalysis, pregnancy test, glucose test, hematocrit, etc. same thing. These are items you can clearly see in the note were provided, just left off the billing form.

If you have a superbill that has incorrect procedures circled, or missing more than just a minor procedure code, that probably should go back to the provider for clarification. This would be a good time to get in writing a policy and procedure for dealing with these situations.

Remember, superbills are just a tool used to communicate information regarding what happened in the encounter. A corrected superbill is not documentation and is not used in an audit situation, so changes made to a superbill would not need official letters of explanation. As long as what is billed to the insurance accurately reflects what is in the encounter notes you are covered in an audit situation.

 

[mitchellde]

Arlene is correct, you do not need to "correct" the superbill as long as the claim can be matched to the documentation. If you see an incorrect procedure code you can change it and the same is true of the diagnosis code. If you feel the visit level should be a different level then yes you can change it but there is a lot of subjectivity built into the E&M guidelines so for that you need to be sure you and the provider are seeing things the same way.. IMO. But you do not need permission to change a dx code or add a procedure code or even delete one as long as what you select follows the guidelines and definitions and is documented.
However it is probably a good idea to communicate changes.

 

[kbarron]

Thank you for your responses. When in was in single practice, I would go to the provider and tell her what I was changing and write on the superbill the reason for code changing per attached note. I never had any problems. Now there are 13 practices and if I have to correct every error and create a letter to the providers letting them know of my findings, I probably would'nt get anything else done! I needed proof as new manager wants all errors, no matter how small send back to provider for correction with a note from provider stating the reason superbill is being changed. I would not do anything that was not compliant.