Wiki Incorrect Codes and Corrections

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Debbie C

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:confused: Hello everyone, I am writing to find out if there is a link or information you can provide in relation to the wrong code being billed by the provider and the Certified Coder legally being able to change that code without the permission of the provider. I attended the AAPC conference/training and had a discussion with one of the AAPC leaders.

My understanding was; If a provider bills for services but chooses the incorrect ICD 9 code, a certified coder is the only person, other than the provider, that can legally change a code to the correct code based on documentation. Example: documentation states patient has DM Nephropathy, CKD Stage 3 due to DM 2 (controlled) and was coded 250.00. The correct codes should be 250.40 and 585.3. OR a provider billed 185. As a current condition but the patient really has history of prostate cancer and no longer under any type treatment, correct code would be V10.46.

Did I understand correctly that a certified coder can delete the incorrect codes and rebill the correct codes without physician notification? If yes, can you provide some type of Link and/or documentation that will support that so I can share it with my supervisor?

If I am incorrect in my understanding, could you please clarify? Thank you all so much for your time!!!
 
It is correct that a coder can change the codes based on the documentation and does not have to notify the provider. However I know of no links to any official site for this info. Only that the job of the coder is to apply correct codes from the documentation. However there is also no official source that states the provider must supply the codes which then must be used.
However it is wrong for a coder to submit codes based on what the provider selects without a review of the documentation, and if a coder knowingly submits a claim with incorrect codes because they felt that they could not change them , then that is a whole other story!
 
The ICD-9 code submitted on the claim must be supported by the documentation. Ultimately, the provider is responsible for the coding of his services so the liability lies with the provider. As far as the "correct coding and sequencing" of the ICD-9, it is documented in the Official AMA coding guidelines. I work for a large group of 80+ providers owned by our hospital. We have a policy in place that a coder cannot change any of the provider's coding without their approval. However, we do hold from billing if the coding is not reflective of the documentation and until the provider approves the change. This is just a policy, not the law. A coder should always stay compliant with their coding and might need a higher authority to prove to the physician. But I think the AMA Coding Guidelines will suffice. Good luck!
 
My physicians do not give me the codes for their hospital patients or their outpatient surgeries. I code those myself by abstracting from the OP note or H&P.
They do mark things on the routing slips, but I code from the dictation, so whatever is stated in their dictation is what gets coded.That is a practice policy so the physicians are aware that simply marking something on the routing slip is not good enough.
 
donna_vig said:
The ICD-9 code submitted on the claim must be supported by the documentation. Ultimately, the provider is responsible for the coding of his services so the liability lies with the provider. As far as the "correct coding and sequencing" of the ICD-9, it is documented in the Official AMA coding guidelines. I work for a large group of 80+ providers owned by our hospital. We have a policy in place that a coder cannot change any of the provider's coding without their approval. However, we do hold from billing if the coding is not reflective of the documentation and until the provider approves the change. This is just a policy, not the law. A coder should always stay compliant with their coding and might need a higher authority to prove to the physician. But I think the AMA Coding Guidelines will suffice. Good luck!
Click to expand...

FYI the liability also lies with the coder! It is not solely or even ultimately with the provider. It is a shared liability, coder and provider. There were several articles on coder liability in the coding edge several years.
 
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