Need advice on dealing with Mental Health providers


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Hi I really need some advice on what I should do in this situation.

I code for all the mental health providers in my practice. There is one in particular who seems to end up having cases where the patient was abused in the past. Unfortunately one of these patients is a still a child. When I brought the idea to code for the abuse that the patient mentioned in the report. I was met with, my manager and her manager coming to talk to me about why I had even asked about it, and why I even need to read their progress notes. I explained the situation and legality of it. I tried to explain this to the provider when I sent the claim back to her as well. After that big attack toward me for trying to help her patient, and the provider.

The providers response was basically that she is not treating the patient for it. Which I would think is just not true. How can someone go thorough that, and have it not be a part of why they are depressed or anxious? Also considering that it is in the progress note, that seemed to convey that it happened in the past. Past victims often always become victims again, especially when they are not taught anything to prevent it from happening again. Which according to the provider she isn't doing by stating that she is not doing treatment based on that. Also if she is basically sweeping this under the rug, she believes she is protecting the patient, which she isn't. She is protecting the person that did this. If it were to happen again, and there is no evidence that the patient was being treated for it, and if she won't stand up for her patient, then it's possible to not be believed.

Also since this happened, according to her manager she got really upset at the fact that I read any of the mental health providers notes. Which I have to do because well, they are not very good at coding really at all. I had to fight to get them to even put the amount of time spent with the patient in their progress notes. Also it seems that this provider has responded by putting next to nothing in her notes, and consistently still not providing the time spent. I feel like because I brought this up that she thinks I'm a creep or something. I don't know what to do. Because I feel like maybe she doesn't even know that when abuse is even suspected it needs to be reported to authorities. It's like I feel that if there was someone that came to see her because they are being abused, she wouldn't report it and that's a crime.

I think I am going to talk to her manager because it's just silly that she's acting like this. I'm trying to help her and her patient, and shes just like no.


Las Vegas, Nevada
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I would talk to your manager and explain the ethics of coding for these types of diagnoses. Even suggest that there should be written guidelines for the reporting of abuse (history, etc) so that the entire practice is on the same page (this may take several meetings for all involved). Also emphasize that you are a professional as well and your credential is on the line for incorrect or absent coding and if changes can't or won't be made, you would seek other employment. Coders have a liability as well as the providers of care for correct documentation and coding. Good luck.


True Blue
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I agree with the post above that trying to work constructively with your manager here is the best approach - getting into conflicts of this sort with your providers will not likely end well for you and I would leave this to management to work out as that is their responsibility once you have brought the issues to their attention.

Whether and when abuse needs to be reported is an issue that has a lot of legal implications and as I'm not an attorney and do not know the laws of your state of practice, can't advise on that. It's fine to bring that to your manager's attention, or to report it if you feel there's a potential compliance concern, but if you're not an expert on that or if it's not within your role, I'd say it's best to defer to those who are responsible.

From a coding perspective, and speaking from my own experience, I'd advise caution in how you approach providers with feedback or recommendations about their documentation and/or coding issues. Whether intended or not, providers can easily misinterpret such advice as an intrusion into their own practice and patient care. I don't know what your clinical background is or your assigned roles with the practice, but much of what you've said above could sound to a clinician like someone who is untrained trying to step outside of their role and interfere with their care decisions, and I'm not surprised that this would not sit well with providers. You may not be aware of it, but your tone really does come across as quite disrespectful of your providers. Now there are some bad providers out there for sure, but are you really able to make that determination? Keep in mind that these are the providers' patients, not yours, and the providers are ultimately the ones responsible for the care and treatment - they are the ones that have gone through the schooling and credentialing to do this work and it is their license that is at risk if anything goes wrong. Coders have a valuable role to play in that we can offer our knowledge coding, billing, compliance regulations, audit methods, etc., to help make a practice work better. Your work can be an important part of a making a practice better, more profitable and more compliant, but in order to achieve that, it's also important to be able to collaborate with your providers and managers to maintain a good working relationship. And recognizing that providers are the experts in their areas, just as you are in yours, is key to making that work.