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Surgeon wants to bill all codes regardless of CCI

  1. #1
    Default Surgeon wants to bill all codes regardless of CCI
    Medical Coding Books
    I work for a surgeon in the specialty of Urology. There are many of the procedure codes that are performed together that, accourding to MCR CCI edits, cannot be billed together as they are considered bundled. He is asking me to bill those codes anyway knowing we will not get paid. He feels this is a more accurate record of what was performed in surgery.

    However, I feel adding those codes may trigger an audit of some kind, since it looks as though he is attempting to routinely bill unbundled codes. Being certified I am more comfortable not billing the bundled codes, however he is my employer, so I would like to accomodate his requests if at all possible.

    Any advice on this subject? Ive read some of the "How to use the CCI" articles from Medicare, but it never seems to state what happens if you DO bill the codes. (other than kicking them out and not paying them)


  2. #2
    As a certified coder, we signed an "Ethics" clause in our membership. That means that if you know it is wrong, do not code it. The physician needs to be brought up on the AMA coding guidelines. I worked for a physician just like yours at one point (also urology). I had to literally print out materials, CPT Assistant, AMA coding guidelines for him to read and understand.

    Many physicians in specialties such as urology where the procedures can be daunting and very long, they tend to want to get reimbursed for all the procedures, or submit all the codes as they feel they should. However, if you code all of the codes and they are bundled, as an auditor and as a payer, you will be red-flagged for unbundling procedures and will be audited.

    My suggestion would be to print out as much information that you can and present this to your office manager. You at that point have done your ethical duty and let her handle it from there.

    If you need further, please let me know
    Amy Pritchett,
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  3. #3
    Seacoast, Dover NH
    You could also suggest that your provider check with the American Urological Association - - if they are a member they have access to coding information that directly impacts them.

    I don't think Amy could have said it any better! I would gather the info and turn it over to the practice manager.

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