Wiki Policy for Selecting E/M Level

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caramella025

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Can an outpatient physician's clinic implement a policy that the coder doesn't change the e/m level because they want to establish a written policy that the physician is responsible for the e/m selection? I would think the coder should determine e/m level since they are checking the documentation for accuracy and making sure that it supports the level selected. Has anyone had experience with a practice that has such a policy? Does a written policy eliminate the repercussions for a coder if an audit happens? I just want to be covered. I appreciate any feedback.

Thanks,
Melanie
 
Job Description

Melanie,

I still see many practices where the providers do E&M coding. It's not a great idea, but they do. I'm guessing that you are then only left with I-10 coding? If that is all you do and you have no coding or audit responsibilities for E&M for this clinic, I don't see how you would be responsible for their coding. But if your job description calls for E&M coding for this clinic you might ask for a change in your job description. Also at a minimum they should be having their E&M audited regularly for correctness and compliance with documentation. Maybe if you do the auditing that would be reasonable and a way to move jour job toward auditing.

Jim
 
Thanks for your response. Currently the provider picks the level, but as the coder we check the documentation and make sure that the level is substantiated, along with diagnosis and any other procedure coding. It has been our responsibility to make sure everything is submitted in accordance to coding guidelines. In efforts for more productivity each day they want to eliminate the coder making any changes to the e/m level. But in honesty, the level needs changing most of the time. The documentation is usually lacking. The thought from management is that they can implement a policy that the physician is solely responsible for e/m selection. We don't have a compliance officer here and my concern is that I'm the one submitting that charge. If I see that the level isn't warranted, I don't feel comfortable not correcting it.







jimbo1231 said:
Melanie,

I still see many practices where the providers do E&M coding. It's not a great idea, but they do. I'm guessing that you are then only left with I-10 coding? If that is all you do and you have no coding or audit responsibilities for E&M for this clinic, I don't see how you would be responsible for their coding. But if your job description calls for E&M coding for this clinic you might ask for a change in your job description. Also at a minimum they should be having their E&M audited regularly for correctness and compliance with documentation. Maybe if you do the auditing that would be reasonable and a way to move jour job toward auditing.

Jim
Click to expand...
 
If you knowingly submit a code for reimbursement that you know is not supported by the documentation, do you not feel this will make you legally liable? You are maybe not liable for selecting it but you are liable for submitting incorrect information.
 
Thank you for your response. Yes, I agree completely. This has been my position on this subject but I wanted to make sure that I was correct before I take this to my supervisor.
 
I agree too. It's one thing to have a policy that providers can select their own codes, but quite another to do so without taking steps to ensure that this is done accurately.
 
policy

What if you are told you can not change the level of service per policy its the providers responsibility and that is why we do inside auditing. I'm at a new job and this has bothered me a lot but I'm told I will not be held responsible. Its a fine line and I can't really afford to lose my job but I can't afford to get in trouble with OIG/Medicare others either... :confused::confused: I'm in a hospital setting but billing for the physicians E/M only...
 
caramella025 said:
Can an outpatient physician's clinic implement a policy that the coder doesn't change the e/m level because they want to establish a written policy that the physician is responsible for the e/m selection? I would think the coder should determine e/m level since they are checking the documentation for accuracy and making sure that it supports the level selected. Has anyone had experience with a practice that has such a policy? Does a written policy eliminate the repercussions for a coder if an audit happens? I just want to be covered. I appreciate any feedback.

Thanks,
Melanie
Click to expand...

Hi Melanie.

Maybe this is a perfect opportunity for physician education. If they're responsible for the E&M code selection and you've reviewed the note and find it doesn't substantiate the level of service, you can then update and educate them. It is then their responsibility to update the correct code before billing it and I believe alleviating you of undue consequences due to the fact you did inform the provider of the correct code.

Just my nickel in this conversation.
 
Coding policies

Would you be willing to share your coding policy? We are opening a coding position which we have never had before and I need a policy draft ASAP. If not, can you lead me in the right direction to find an example?

TIA

Tara Smiddle CPC
 
Clarification

Just wanted to check with you on your procedure. If you disagree with the E&M based on documentation do you return it to the provider for their re-coding? At a minimum the provider should either re-code or support in writing the Level they coded. I assumed that was what you were doing (maybe wrongly). If you are identifying many miscoded charts based on documentation and based on policy they are being submitted with the wrong code, I agree that is a potential problem for everyone. You mentioned that the practice doesn't have a Compliance Officer which I'm guessing mean they don't have a compliance plan (or if they do it's inactively sitting in someone's draw). Those are also potential problems. Smaller practices that can't afford a full time CO can still afford to have someone qualified in that role on a part time basis.
If effectively you have no real say over E&M coding I would still recommend a change in your job description.


Jim
 
No, we don't return it, we currently change the level to whatever the note substantiates.


jimbo1231 said:
Just wanted to check with you on your procedure. If you disagree with the E&M based on documentation do you return it to the provider for their re-coding? At a minimum the provider should either re-code or support in writing the Level they coded. I assumed that was what you were doing (maybe wrongly). If you are identifying many miscoded charts based on documentation and based on policy they are being submitted with the wrong code, I agree that is a potential problem for everyone. You mentioned that the practice doesn't have a Compliance Officer which I'm guessing mean they don't have a compliance plan (or if they do it's inactively sitting in someone's draw). Those are also potential problems. Smaller practices that can't afford a full time CO can still afford to have someone qualified in that role on a part time basis.
If effectively you have no real say over E&M coding I would still recommend a change in your job description.


Jim
Click to expand...
 
I feel your pain.


tmcquegge said:
What if you are told you can not change the level of service per policy its the providers responsibility and that is why we do inside auditing. I'm at a new job and this has bothered me a lot but I'm told I will not be held responsible. Its a fine line and I can't really afford to lose my job but I can't afford to get in trouble with OIG/Medicare others either... :confused::confused: I'm in a hospital setting but billing for the physicians E/M only...
Click to expand...
 
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