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"Pre-Coding"

K

Klpearson

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Newport News, VA
I am in a discussion in regards to coding before a patient is seen. I work in Home Health care and personally feel codes should not be assigned until after the patient is seen. I was curious to any thoughts on the subject.
 
There was another discussion about this not long ago where a doctor was filling in codes before the patient was seen. I agree that this should NOT be done - how does the provider know that these codes will be correct before actually diagnosing and treating the patient?????
 
That is my rationale also but then the question "Is it legal?" was asked. I stated i felt it's not legal but it's also a bad habit. If someone forgets to go back and tweak the codes then we submit a false claim.
 
Klpearson said:
That is my rationale also but then the question "Is it legal?" was asked. I stated i felt it's not legal but it's also a bad habit. If someone forgets to go back and tweak the codes then we submit a false claim.
Click to expand...

That's the key to that question - you would be submitting a false claim, i.e. ILLEGAL, if the codes do not reflect the diagnosis and procedures performed.
 
pre coding.

I have coded for a stand alone radiology. The orders would be faxed or put online. I used the LCD list mostly for the ordes coming for CT's,MRI and general. Depending on the results that the Radiologist dictated, the codes sometimes would change. If symptoms and/or reasoning did not match up we would call the clinic. We always pre coded by using Medicare rules. I could if something else showed other than signs and symptoms, I could lead to a billing issue.
 
You cannot use an LCD to code the patient diagnosis as a reason for the test. YOu are to code from the providers notes, which means you should ask for the office note with the order , or at the very least call the office. But Never should you be selecting a patient's code from the LCD. You use the codes that fit the provider's orders. If signs and symptoms are all you have then that is what you use. By using the LCD how many times have you assigned a diagnosis the patient does not have!
Also Medicare has no rule that covers pre coding. Medicare rules state to code based on documentation. The LCDs/NCDs are there for the provider to know when an ABN is necessary and when the patient should be expected to pay, they are not a "cookie Cutter" to be use for coding the claims.
 
Back to the Original Question

Working in Home Health, do you mean an in for an agency that employees nursing and other ancillary medical staff to tend at persons at home?

If that being the case, wouldn't you need an order from the patient's physician for the home health care stating the patient's diagnosis and reason for home health care? The home health staff, I don't, are permitted to make diagnoses on patients.
 
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