1. Did you ask him? Maybe you should discuss his documentation and give feedback? If you are not comfortable, have you asked a manager or supervisor?
Documentation is, unfortunately, not part of my job description when it comes to IP cases (when this appears its always in relation to a complex trauma and he is performing multiple surgeries over days or even weeks).
2. What do the actual procedure or surgery reports say?
This code is "suggested" along with anywhere from 5-15 other procedure codes. Since these are trauma procedures, the documentation can be 4-5 paragraphs, and copying the whole thing would be too risky IMO.
3. Is he just using a really old and/or outdated template without looking at it and doesn't even realize it says this?
He's middle aged.
4. 21236 is not a CPT code.
I know!!! Thats what I am trying to figure out--I'm sure he is referencing a valid code, or maybe even a deleted code, I just have no idea which one.
5. "Just attaching" a 22 modifier is not a good procedure.
I am actually reading the whole op report, and like I said, based on the op report whichever other valid CPT actually describes the majority of the work, I will attach the modifier to if it makes sense. He uses the canned phrases like "there was an extensive amount of work required" or "due to the {insert reason}, the procedure took longer than usual" but sometimes where he puts them doesn't make sense....like he will put it in the paragraph where he's describing 15002/03, and say "due to the presence of eschar, extra surgical time was required" but...that's literally why we are billing the 15002/03 in the first place. His records regularly take me an hour or more because I am reading the op report and comparing it with the integral steps to the procedures to see if the -22 is needed.
6. If you break down the report and outline the headers with the body of the op note, do they match? Do they make sense? Is everything accounted for? Does the report even support a 22?
We don't use headers. If I'm lucky they break up the documentation into paragraphs, but its not uncommon to have 3-4 procedures in a single block of text. See above for the rest.
7. Are the claims being denied or rejected or is the provider getting more medical record request than others? Do his claims take longer to pay?
They did actually email me the other day because his RVU's are sky high...since he is the only one who does MF traumas, it kind of makes sense. I have no way of tracking the A/R side of it in my current job, but based on what I know about other "problem children" I've had in the past in other jobs....he probably does get a lot of record requests.
8. Providers listing the actual ICD-10 and CPT codes in reports is not a great practice in my opinion. They need to use words, not codes.
They use both. Basically they use the lists for themselves, but by no means are the coders handcuffed to their choices (which is nice, because at my last job we were).