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Physician Coders copying off Hospital Abstract

  1. #1
    Default Physician Coders copying off Hospital Abstract
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    I am looking for documentation that will support that copying off the hospitals coding summary/abstract to submit billing for professional services is wrong.

    I have recently been informed that this is a widely used practice. I know it is wrong. I don't know if it is just ethically wrong or if there are guidelines that address this practice.

    The hospital is sending the coding summary to the physician's office per their request. They are submitting billing based on the codes selected by the facility coder, whether they are outpatient or inpatient services. This practice allows physicians to not have to employ Certified Coders. In fact, this practice would allow the physicians to employ a trained monkey to copy codes from one paper to another. What type of responsibility does the facility have? How would one convince the physicians that this will lead to troubles for them in the future?

    We all know as Certified coders that we would not trust the abstract and we would never allow our name to be put on someone elses codes.

    Please, anyone send reference material information.

  2. #2
    Default Copying
    Quote Originally Posted by Icode4U View Post
    I am looking for documentation that will support that copying off the hospitals coding summary/abstract to submit billing for professional services is wrong.

    I have recently been informed that this is a widely used practice. I know it is wrong. I don't know if it is just ethically wrong or if there are guidelines that address this practice.

    The hospital is sending the coding summary to the physician's office per their request. They are submitting billing based on the codes selected by the facility coder, whether they are outpatient or inpatient services. This practice allows physicians to not have to employ Certified Coders. In fact, this practice would allow the physicians to employ a trained monkey to copy codes from one paper to another. What type of responsibility does the facility have? How would one convince the physicians that this will lead to troubles for them in the future?

    We all know as Certified coders that we would not trust the abstract and we would never allow our name to be put on someone elses codes.

    Please, anyone send reference material information.

    I agree with you. I would never take someone elses code and put my name to it. For more than one reason, but the #1 reason is: If I get audited for this account, how can I explain and defend those codes. "Someone else did it" will not be an explanation anyone is willing to hear. You must be able to defend what you have done. (i.e. why did you use this dizziness code instead of vertigo code. Why did you use epilepsy instead of seizure). There are too many instances when your codes could be questioned and they should always reflect the documentation and an abstract just doesn't cut it for defense. The other question, is why is the hospital allowing this to happen? Why aren't the coders stopping this? Sorry, I don't have any reference material, but I will certainly be looking. I feel for you.

  3. Default Reply
    Oh, this is so so wrong. I will also be looking for documentation also to support your case to the providers.
    ~Amy, CPC, CPMA, CEMC~
    Auditor/Consultant

  4. #4
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    Default
    This reminds me of a very similar practice I encountered while consulting.

    I am unclear on your role within this process though. You are obviously uncomfortable with the physician practice's conduct, but I'm not sure about your employment with the facility.

    As for guidelines and the ethics here, we can pretty clearly establish that a.) this is an unethical practice and b.) it is antithetical to sound compliance practices. Outside that, there are probably several other conclusions we could draw, but I probably won't visit those.

    Guidelines for physician services diagnostic coding are substantially different. If your job is to convince this practice of the opportunity for problem, simply pull a discharge summary where the patient is given a "probable" Principal Diagnosis. The physician claim for services on the day of discharge would also likely have that probable diagnosis coded as if it existed. Now extrapolate that to the length of time they've spent in doing this, by the number of patients treated annually and there's just a general figure on how many possible coding errors are out there.

    If you work for the hospital supplying the coding abstracts, see what you can do about cutting them off. Those abstracts aren't coded for physician services use--they represent facility fee coding. The abstracts are really the administrative record of the hospital and therefore the hospital is under no obligation to disclose that.

    In the event you'd happen to be on the payer side, promtply refer this case to a program integrity unit. The claims that the provider is submitting are not correct and some serious education should be done.

    This isn't a case of physician coders using the hospital abstract, it's a case of a physician practice using the abstracts--if they had real coders on staff, this wouldn't be taking place!

  5. #5
    Default Code copying
    Thank you Kevin, I always enjoy reading your advice.

    My role is outpatient facility coding. I am not an employee of the hospital, I am a contract employee. I questioned why I was printing 3 copies of my coding summary. I was told that the physicians use the codes to bill insurance. This is a small town; they do not employ certified coders. From my experience, and I am sure there are others with the same. I uncover so many things that are incorrect, un-ethical, and borderline fraudulent practices. This frustrates me. At this facility, I view the physician's documentation in the charts and I am appalled by what I find. Discharge summaries that are one liners “Patient meets discharge requirements, discharged to home”. No final exam, no description of the hospital stay, nothing. From what I see there is no processes in place to require the physicians to maintain the hospital records adequately. I also work for a large hospital in a large city. There is no “monitoring” of the content of the physicians progress notes there either. However, the physicians employ certified coders that help with more complete documentation.

    I am very puzzled and frustrated why these practices are not corrected. I want supporting information that I can take to the hospital and/or physicians that speak to the liability and ethical position that this places them in.

    OR…………just turn my head and just do what I get paid to do and ignore all of this?

  6. #6
    Default Kudos
    Congrats to you Kevin. I read about your career Kudos in the Coding Edge!

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