Wiki Proper and consistant coding

[lillianivy]

I need help. I am the primary coder in our office and have been the only one for the longest time. We have recently increased our services, therefore, have hired a part-time coder to help when needed. We have set policies and procedures. The new coder refuses to comply. She has been coding for years and set in her ways. And due to certain personal circumstances she cannot be let go. I have informed her the importance it is to be consistant and the fact that we follow NCCI coding edit/CPT/ICD-9/HCPCS guidelines. I have spoken with my supervisor and have been told since I am the Main Coder it is my responsibility to inform her and have her comply. Yet, no authority to discipline.

One of the issues is the order of the CPT codes. We can have up to 20 or more CPT codes on one claim. If you plug in all codes in a NCCI edit tool it list the codes in a certain order. Therefore, we have been listing them in the proper order when billing. And have been for years. She refuses to comply with this and argues that it doesn't matter. Is there any document out there that can state the importance of proper order of CPT code billing. I've been taught in school that this is the proper protocol, plus when studying for the exam before I took it, it was clear that the codes needed to be in a certain order. Same goes with DX. Which all facilities have there own policies they comply to. Previous coding jobs I have had the same policy that had to be applied.

There are other policies that she also does not comply with, that relate to our facility's personal policies. We put certain data in line 19 and have been for years. Certain insurance's will pay for some services and some do not, therefore I bill for those services. She refuses to bill for those services at all. Claiming it's not necessary. My thinking is every insurance policy is different and if they pay for that service then you bill for it. Plus we are loosing money when she refuses to bill for it.

I guess my main concern is with this inconsistent coding, could this possibly lead to attention from all insurance companies. I definitely don't want to draw attention to us to cause an audit. Is there any articles or information that can help support my case. Or tell me that CPT codes being billed in a certain order does not matter. It would be nice to have in writing Guidelines/Articles that support my argument and to support our facilities personal policies being followed.

Thank you!!!

 

[mheiderpayne]

I would show her the denied claims that she submitted then show ones that other coders submitted and then point out the differences. Good luck.

 

[cldavenport]

"And due to certain personal circumstances she cannot be let go". This statement is quite interesting. But what it all boils down to is loss of revenue. I understand you have spoken with your supervisor about this situation. If I were you, I would bring forth evidence of loss of revenue to your supervisor. Maybe then will it become apparent how this inconsistent coding is affecting the practice/revenue. Good luck!

 

[MnTwins29]

Piggbacking off of cldavenport's advice, show how the code order of the other coder's work will result in lower revenue. There are several sources that advise to list the code with the highest reimbursement or RVU values first, then in decreasing order.

As for diagnosis coding, the ICD-9 Coding Guidelines for Outpatient Services (which do include office visits) clearly state that the first listed diagnosis code is the one for the "diagnosis, condition, problem or other reason for visit shown in the medical record to be CHIEFLY RESPONSIBLE for the services provided" (caps mine for emphasis).