Wiki Importance of Correct Coding


Temple City, CA
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How can I make my Manager aware of the importance of coding office visits correctly. She recently hired a person who did an online billing and collections course. This person has no medical background but the online course she recently took and passed with a certificate of completion. Another issue is that this person is a close family friend to her. With that being said, she has her doing coding and charge entry. She hired her to do collections and notified the entire office that she was going to be doing collections and that her title is Collector. I have came across several charge tickets that she is coding and entering and sending to insurance companies to get paid. The coding is totally off! I brought this to the attention of my manager and offered to help with the coding and suggested that she does the data entry portion of it. Her response was no, but I appreciate you offering to help. As a coder with over 10 years experience in coding/billing/auditing, I am very frustrated with this situation! What would you do in this case. Any suggestions??
Thank You! :confused:
Is she up coding the office level? Is she adjusting the dx codes? Is it a combination? You need to impress upon her how her actions are affecting others. By upcoding the visit levels to something not met by the documentation she puts the entire office at risk, including the doctor. By changing the dx codes she puts the patient's at risk. They can lose benefits, their premiums can increase, etc.
In an old edition of The Coding Edge, there was an article on "How Much are Your Coding Ethics Worth" In this article it was stated that if you know something is being performed incorrectly and you take no action to correct it then you are just as liable as if you had performed the action. If the activity does not change then it is best that you dismiss yourself from the office and report the activity.
It is unfortunate that this has happened, but it is something I see all too often when I go into a practice to perform an audit.

I agree with Debra. I have faced the same situation and rather than face the penalties also, I walked away. However, you could go to the lead physician in your practice and address the issue with him/her since it will affect them also, and you may or may not get any support, but at least it is worth the try. I have gone to physicians before and if you have as they say "all of your ducks in a row" meaning you have documentation/proof to back up your statement, they are usually willing to listen, as many of them like to see things in writing.

I hope this helps and best of luck to you!


i also agree with debra. i was in a similiar situation as you and was terminated for disagreeing with the manager over her friend she hired. But later was happy, when i found the offifce was audited.