Physician responsibility for CPT codes

bstephen

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Can anyone tell me where I can find documentation to support the practice that PHYSICIANS are ultimatley reposnsible for assigning E& M codes? I have audited a practice in which the physicians have no input in the assigned codes & coding office encounters appears very arbitrary. I was looking for some Medicare regs or soemthing that I can show them....but I can find none.

Thoughts?

Becky
 

rharmon

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Some of my providers will come and ask billing level questions after seeing a patient because they are not sure. We do charging for some ER doctors and we code the level based on the documentation presented to us and bill based on that. I really don't think there is anything anywhere that states it is ultimately their responsibility to select the E&M code but they need to support whatever is charged out by documentation of their work.
 

scorrado

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This same question came up in our office yesterday so I am very anxious to hear how others feel on this subject. I think ultimately the documentation has to stand on its own no matter who coded it.
 

jbolton

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We had a speaker from Colorado Rural Centers do a short presentation with our providers a few months back. They were explaining that the physicians are ultimatley responsible for what is billed out. She explained this story about a physician who let a 3rd party bill out his E&M Levels, they were all wrong. He was audited and is having to report to CMS and the OIG on a regular basis. I guess that the coding facility was not held responsible at all. One of our providers was terribly upset that he could be held liable for what is done on the back end. At our facility, we are encouraging our physicians to choose their own E&M ( as they should be), but in the past, we have always done it for them. Since I am no longer coding for family practice, we have many inexperienced and un-qualified individuals in MR now who choose the levels and other CPT codes and they are wrong. Bad news for us. I would encourage your physicians to do the research and I think they will find they should be choosing as they are the ones who truly know how in depth they were with the patient. The documentation needs to support it, but I strongly encourage physicians to choose their own CPT codes if possible :)
Jaime CPC, NCP, EMR Specialist
 
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response to physician responsibility for CPT codes

...the provider is accountable for what the progress note says....it's the company's discreation to say who can and who can not code for the company....yes, a certified coder is more apt to be efficient....you can't beat city hall
p.s. we're going thru the same thing with my company-the physicians code at a 80% accuracy rate and the company is complacent with the statistics lol lol

Can anyone tell me where I can find documentation to support the practice that PHYSICIANS are ultimatley reposnsible for assigning E& M codes? I have audited a practice in which the physicians have no input in the assigned codes & coding office encounters appears very arbitrary. I was looking for some Medicare regs or soemthing that I can show them....but I can find none.

Thoughts?

Becky
 
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