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Not Coding for Services Rendered?

mungojerrie

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I had a discussion with the physician in our practice this morning about not coding services rendered. She doesn't code services she finds to be minimal (97012, 97035, 97032 in a Chiropractor's office) and doesn't charge the patient for them.

I was always taught that EVERY service rendered in the office must be coded. :confused:

Can anyone give me any insight on this or maybe refer me to any statutes that might require this?

Thanks so much!
 
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4,466
Location
Milwaukee WI
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She is putting her practice at risk for audit

If she is not coding any of the "low" level services then pattern of coding will skew unnecessarily high ... putting the practice at increased risk of an audit.

At such an audit she will need to explain and prove that she applied this ill-thought-through protocol uniformly across all patients (woe to her if she has billed even ONE patient while "forgiving" all the others).

Additionally, for some insurers they need to see evidence of more conservative treatment before authorizing more aggressive measures. If she's not coding the lower level / conservative treatments she'll have no proof of that approach.

Providers should document what they do. Coders should code what is documented.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

RebeccaWoodward*

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3,126
Location
North Carolina
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If she is not coding any of the "low" level services then pattern of coding will skew unnecessarily high ... putting the practice at increased risk of an audit.

At such an audit she will need to explain and prove that she applied this ill-thought-through protocol uniformly across all patients (woe to her if she has billed even ONE patient while "forgiving" all the others).

Additionally, for some insurers they need to see evidence of more conservative treatment before authorizing more aggressive measures. If she's not coding the lower level / conservative treatments she'll have no proof of that approach.

Providers should document what they do. Coders should code what is documented.

Hope that helps.

F Tessa Bartels, CPC, CEMC

Well stated, Tessa...
 
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