I am looking for source documents that deal with criteria for CPC's (certified professional coders) being able to audit and select a level of service for the provider. I want to make sure the provider doesn't need to select the level of service after dictating his note bit I can as a certified coder for him.
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Wiki Sheri N. CPC
- Thread starter sherin
- Start date
Are you setting up a policy or challenging an existing policy?
This is more of an internal issue offices need to deal with. There are documents that show the value of having CPCs audit and code and the OIG generally uses CPCs when they audit, but to my knowledge there is no document that says what CPCs can or can't do. That is part of the individual job description.
If there is something I hope someone posts it. Just being a CPC does not automatically qualify someone to do all types of coding and auditing so I doubt there is that type of document out there.
Sorry not more helpful,
Laura, CPC, CEMC
This is more of an internal issue offices need to deal with. There are documents that show the value of having CPCs audit and code and the OIG generally uses CPCs when they audit, but to my knowledge there is no document that says what CPCs can or can't do. That is part of the individual job description.
If there is something I hope someone posts it. Just being a CPC does not automatically qualify someone to do all types of coding and auditing so I doubt there is that type of document out there.
Sorry not more helpful,
Laura, CPC, CEMC
mitchellde
True Blue
I agree with Laura. As far as the question, should a coder be qualified to evaluate the documentation to assign the correct visit level? the answer is absolutely! As long as we use the guideline set the physician desires and we review the documentation there is no reason this canont be performed by a coder. But I as I am sure you have run across coders that even though they passed the test, still are very bad at performing this function.
Provider involvment
Obtaining a specialty certification (and/or the upcoming auditing credential!) would also prove your knowledge and commitment in that specialty and to coding, but it is important to remember that the provider is always ultimately responsible for all the coding and billing submitted under his/her name and number. At some the point, the provider should be aware of the coding being submitted. Whether those codes are initially marked by the provider, but later changed after the certified coder reviews and audits, or coded during auditing of the record, the provider is responsible for the claims being submitted under his/her name and should always be involved in the process.
Obtaining a specialty certification (and/or the upcoming auditing credential!) would also prove your knowledge and commitment in that specialty and to coding, but it is important to remember that the provider is always ultimately responsible for all the coding and billing submitted under his/her name and number. At some the point, the provider should be aware of the coding being submitted. Whether those codes are initially marked by the provider, but later changed after the certified coder reviews and audits, or coded during auditing of the record, the provider is responsible for the claims being submitted under his/her name and should always be involved in the process.