Provider addendums on changed or corrected dx codes

arrana

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Local Chapter Officer
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Our providers select their own ICD10 codes in our EMR. Unfortunately, the EMR dx code descriptions are not always accurate to the true code definition in the manual. For example, our EMR may have the description of bilateral, but the code is right or left, not bilateral. Because the providers don't know the codes and are searching for the codes by terminology, they believe they have selected the correct code, which, unintentionally, results in a lot of coding errors. As certified coders we catch most of the errors before submitting the claims and as long as the documentation is specific, we will change or correct the diagnosis code in the claim/billing module, but not in the progress note. In this circumstance we do not typically notify the provider since the documentation supports the correction. If the documentation is not clear or specific, we will query the provider for the correct code and ask them to addend the note.

How does your office handle this type of situation? Do you as certified coders have the authority from your organization to correct diagnosis codes, and if so, do you notify the providers that you have done so and have them addend the note?

Thanks.
 

Agilbert3

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Local Chapter Officer
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SHREVEPORT/BOSSIER CITY
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Still Wondering

I have never heard of a coder having that authority. It would make things much easier, since our doctors do the same. They form a habit of copying the diagnoses from previous visits, so it poses the issue of us coding mostly unspecified since the doctors never update the diagnosis as care goes on.
 

thomas7331

True Blue
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You are following the same process that the organizations I've worked for would have. Per ICD-10 guidelines, "assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists", so codes should always be chosen from the providers' statements and not from their code entries in the record. It's widely known that many providers do not have the training or knowledge of coding to correctly choose ICD-10 codes, and so it is not unexpected to see incorrect codes in an EMR. In my experience, when auditors review coding, the compare the codes on the claim with the documentation itself for accuracy and will ignore any codes that happen to be populated in the EMR system. It should not be necessary to have the provider make an addendum to correct or remove a code as long as the documentation itself is accurate. My recommendation, if your providers are frequently selecting incorrect codes and this cannot be corrected with education, would be to disable the feature in the EMR and relieve the providers from this responsibility. Have them enter a narrative statement and leave the code choices to the trained coders.
 

erjones147

Expert
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405
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Fernley, NV
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I agree with Thomas. Adjust the code to the provider's statement, not vice versa

To answer your second question, I do have the authority to change any code (not any diagnosis) based on proper coding guidelines and the provider's own statements. I am not required to notify them of this change, nor would they care 99.99% of the time
 
Last edited:

Dorthi

Networker
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66
Location
Colorado Springs, CO
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Code issues

We have certified coders who scrub the notes and notify the providers of any discrepancies prior to our billing staff getting them out the door.
 
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