EMDs - Charge Capture/Billing diagnoses

[clynntarpley]

Our software requires that the provider close out their note with a charge capture (selecting a diagnosis and the proper code that goes along with it).
Which is pretty dumb, since the providers are providers and not medical billers/coders.

In every note, below the charge capture, is a 'disclaimer' that reads:

**Please note: ICD descriptions below are intended for billing purposes only and may not represent clinical diagnoses**

So the problem we run into, is - the provider is unable to close out their note without selecting something. When we go to create the
invoices through the system, it automatically pulls their cpts/ICDs from the note to the invoice. The providers, again, are not coders, and browse/select
a diagnosis code that's usually just a ballpark figure, if you will, for what their actual diagnosis is, so they can close out the note and move on to the next.
Once the invoice is created, I go from there and delete the dx codes and replace them with the more appropriate one.


So my question is, if/when one of our payers requests documentation for a claim, does anybody happen to know what effect those diagnosis codes in the actual note have, if any? Our billing manager, understandably so, believes that the notes should be sent back to the provider to have the correct code addendum'ed to the note. But that would be EVERY note! We'd never get anything billed! And it's stupid when they've already documented the encounter, which is their job, and the code selection/whatnot is ours. And then, there's the 'disclaimer,' that states that the ICD descriptions are intended for billing/don't represent clinical diagnoses' (then why the HECK is it a 'requirement' of the note ANYWAY?!)


Any light or rhyme/reason for all this that anyone could shed on this very frustrating topic for us would be so appreciated... Anything besides 'get a new EHR system...'

[pscanlan]

It sounds like you're using an EHR system designed for small practices, not necessarily for centralized coding or billing. That's rough. If I were to guess, I'd say the creators of that software envisioned a coder/charge capture specialist sitting with the provider as they sign off. Either that, or they expect every provider or their clinicians to have coding knowledge, which is unrealistic in the extreme.

I hate to say what you said not to say, but you need a new EHR.

There are, nevertheless, things that you could do, like creating a superbill for each provider with lists of their most common procedures and diagnoses to cut down on the most egregious mis-codes. Or show them how to use ICD10data.com, which can display individual codes, code ranges or search results from natural language (e.g. searching "UTI" pulls up N39.0 as well as the personal history code). I use it everyday instead of pulling out my ICD-10 manual. And it's free! However, if the software you use already has search features and they're still too lazy to select the most specific code possible, I don't think that additional resources will have much effect.

[mitchellde]

It should not be a problem if the note is requested by the payer. The codes on the claim do not need to match the codes selected by the provider but must match the rendered diagnosis provided by the provider. You can also have a programmer program your system with a dummy code.. we used XXX.XX with the description No Diagnosis Code assigned. And the same for CPT. The providers were ecstatic because they never had to look up codes again. They just used that dummy code every time.
Also codes are not required to be in the note. In fact the AHA states that numeric codes should not be in the note, there is that. The dummy code was the easiest solution in for us.

[clynntarpley]

Okay, thanks guys, I appreciate it. It's nice to know we're not just alone in our frustration.

Yeah, PSCANLAN, it's obnoxious. We all hate this system.

And that's not a bad idea MITCHELLDE, about the dummy CPT. I'll definitely run that by her.

Thanks again!