Wiki Separately identifiable E & M - PLEASE HELP STAT!

[nlbarnes]

Hello all - I need help STAT as I'm told to submit charges (E/M-25 & procedure in office) that the doctor enters in addition to a procedure and I am told that I am not liable even when the patient wasn't seen for another reason.

I don't need the policy of using modifier 25. I need in writing that says coders are not liable.

Can anybody direct me to documentation that states I am absolved, not liable, or more importantly lose my certfications for just "submitting" the claim?

 

[thomas7331]

You won't find any such documentation because it doesn't exist - if you participate in wrongdoing, you of course can be held liable. If you're looking for something in writing that will protect you, your best bet is to have your practice's compliance department or legal representative look at the issue and give you a written response. But before jumping to that conclusion I'd recommend taking a deep breath and a step back. This isn't necessarily wrong or fraudulent just based on what you told us. Is it a few isolated cases or is it a pattern of abuse? And is it truly a misrepresentation of services, or is it just a different interpretation or understanding of what the guidelines are? As I'm sure you know, E&M coding and the use of modifier 25 have a lot of grey areas and different understandings. Have you or has your practice consulted with an independent auditor to get their feedback on whether or not the modifier can be supported? If not, is it something you could suggest? I wouldn't panic until you've explored these options. It would be unusual to get into really serious trouble over a for something like this as long as you're making an effort to do the right thing.

 

[ljjulian]

You won't find any such documentation because it doesn't exist - if you participate in wrongdoing, you of course can be held liable. If you're looking for something in writing that will protect you, your best bet is to have your practice's compliance department or legal representative look at the issue and give you a written response. But before jumping to that conclusion I'd recommend taking a deep breath and a step back. This isn't necessarily wrong or fraudulent just based on what you told us. Is it a few isolated cases or is it a pattern of abuse? And is it truly a misrepresentation of services, or is it just a different interpretation or understanding of what the guidelines are? As I'm sure you know, E&M coding and the use of modifier 25 have a lot of grey areas and different understandings. Have you or has your practice consulted with an independent auditor to get their feedback on whether or not the modifier can be supported? If not, is it something you could suggest? I wouldn't panic until you've explored these options. It would be unusual to get into really serious trouble over a for something like this as long as you're making an effort to do the right thing.

I agree!

 

[NeoCoder116]

Responsibility

Look at the Yates memo, it details accountability very succinctly and can even be an educational compliance tool.