Modifying Icd-9 Codes

mharrislow

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As a coder for an FQHC, my co-workers and I are approached regularly by the billing department asking us to modify an ICD-9 code for a claim that has been submitted and rejected. What happens is when the super bill is coded, the coder doesn't always check for a 5th digit therefore resulting in a denied claim. I want to ensure that no Federal laws are being broken if a coder complies with this request.
 

dclark7

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If all you are doing is adding a 5th digit you are not breaking any laws. The claim was most likely denied because the ICD code is invalid since it lacks the 5th digit. If on the other hand they are asking you change an ICD code so the claim will be paid, then you can run into problems. My question to you would be, Are the coders actually coding and entering the super bill? If so, why aren't they checking for 5th digits? Also, do you use a claim scrubber? These usually catch truncated codes prior to the claim being billed.

Doreen, CPC
 
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mitchellde

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My question is why isn't the coder using the documentation to determine the appropriate code an d then looking it up! :)
 

mharrislow

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Dclark7 - Thanks, all we are doing is adding the 5th digit. My company does not use a claim scrubber. Most of the codes that we use are in a computerized library, which is what we majorily use. Some of the coders will put the correct code into the library, but not so that it is usable (which was the error with this case).

Mitchellde - On a daily basis, our facilities house anywhere from 5-10 providers, depending on the location (we have several of them). Because of this, we have a system where the providers use a super bill with ICD-9 codes preprinted on them, and this is what they select. So the only documentation that is provided to our coders is the super bill completed by the provider. With the amount of patients we see daily, it would be impossible to code each encounter from the chart.

Thank you both for assistance. Have a great weekend. :)
 

eadun2000

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Dclark7 - Thanks, all we are doing is adding the 5th digit. My company does not use a claim scrubber. Most of the codes that we use are in a computerized library, which is what we majorily use. Some of the coders will put the correct code into the library, but not so that it is usable (which was the error with this case).

Mitchellde - On a daily basis, our facilities house anywhere from 5-10 providers, depending on the location (we have several of them). Because of this, we have a system where the providers use a super bill with ICD-9 codes preprinted on them, and this is what they select. So the only documentation that is provided to our coders is the super bill completed by the provider. With the amount of patients we see daily, it would be impossible to code each encounter from the chart.

Thank you both for assistance. Have a great weekend. :)
oh boy oh boy oh boy!!! You should NEVER code off of a superbill... it should be coded by abstracting the note!!!!!!!!!! There is no way to know if you are entering the correct codes or not! Just for instance, say patient is diabetic and doc circled 250.00 but the patient had type I diabetes along with a complication that he did not circle on the superbill but was mentioned in the note. I would NEVER, EVER, EVER code off of a superbill. That is NOT coding, that is just plain old data entry and leads to a world of mistakes and liability. Better hope you aren't audited... it would NOT be very good.
 

mitchellde

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THANK YOU EADUNn! That is my point exactly! coding is so important that it be correctly assigned. The providers are not well versed in coding which is why we have coders. It is actually MORE efficient if you look at every chart up front, because the codes will be more correct more times and there will be less "fixing" the claim on the back end. 5 to 10 providers is not so many that it cannot be handled by a couple of coders. The average on a daily basis for outpatient or physician is around 180 claims per coder. So I to respectfull disagree disagree with coding from a superbill, that is not coding and you are still responsible for the code!
 

Mojo

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Providers are not infallible. As coders, we have a professional obligation to patients and our providers to code as accurately as possible.
 

JMeggett

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I find that my Providers circle the wrong ICD-9 on the superbill all the time. They'll circle 836.0 when it really should be 836.1 for example, close...but inaccurate. Then when patient has surgery later for that meniscus tear the ICD-9's don't match all the clinic visits leading up to surgery. Trouble. There are so many possible Dx's that are missed when you don't have the chartnote to code from! What about co-morbidities, or other symptoms that aren't on the list of ICD-9's to choose from? I beg of you to have your Supervisor read over our comments so they can get a clue as to how inappropriate your process currently is. I realize you are doing what you're told, and that the volume of patients seen daily is huge, but claims going out accurately the first time will pay faster than claims being denied and resent...doubling the time at the insurance carrier.

Jenna
 
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