Wiki Superbill Disclaimer

[t.rock.tara]

Help would be much appreciated!

When a physician and coder are both employees of a facility:

Can a disclaimer be put on the bottom of the superbill indicating that if a more descriptive or detailed code is chosen per documentation by the coder instead of physicians choice on original superbill - the more descriptive code will be submitted to insurance w/o notifying physician?

This of course would only be done if Administration okayed the coders recommendation. Hope this makes sense. Please advise, ASAP. Thank you for your time!

 

[pkulczycki]

You can never change a CPT or ICD-9 code without the permission of the physician.

Both you and the physician are responsible for what goes on the claim to the insurance carrier when it comes to fraud and abuse.

If you find a CPT or ICD-9 code that you feel is more appropriate then you need to discuss this with the physician. If does not agree then you must bill what he has chosen.

Peggy Kulczycki, CPC, CPC-I

 

[LLovett]

That is an interesting statement Peggy, what are you basing that on?

Laura, CPC, CEMC

 

[t.rock.tara]

I had also been told this when I was in school but at the time I worked in a private practice so this would make sense. However, my Administration currently prefers that I code per documentation regardless of what is circled on superbill. Other coders have informed me that it would be okay if Dr. had documented a more descriptive diagnosis to begin with. I am aware that I can not submit a code that is not supported by documentation. I am just uncertain if I change any codes that I will need to get Dr.'s approval as this would slow up our billing.

If there is anywhere that I can get this information, please let me know so that I can show my Administration. I appreciate your help. Thank you.

 

[mitchellde]

You can never change a CPT or ICD-9 code without the permission of the physician.

Both you and the physician are responsible for what goes on the claim to the insurance carrier when it comes to fraud and abuse.

If you find a CPT or ICD-9 code that you feel is more appropriate then you need to discuss this with the physician. If does not agree then you must bill what he has chosen.

Peggy Kulczycki, CPC, CPC-I

I agree with Laura. Where did that information come from. You NEVER bill any code that is not supported by the documentation. The question of can you the coder submit on the claim a code that is different from that submitted by the physician yet is supported by the documentation. The answer is of course you can! If it is merely a difference of opinion then you would need to address that with the physician but if it is black and white, he states HTN and submits 401.1, you can, and should change that to 401.9 as that is what matches the documentation, no middle ground. Now comes the question of can you be fired for changing his codes, and of course yes an employer can fire you any time they want for any reason. Yes you are liable for the codes you submit so why would you submit incorrect codes just because the physician says so? So I think a little temperence is needed here, what you CAN do may not be what you SHOULD do, but what you are TOLD to do may not be the WISE thing TO do!