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Difficult Doctor

  1. #1
    Default Difficult Doctor
    Medical Coding Books
    Our hospital employs 12 physicians that our department bills for. One of these physicians has refused to submit his IP and OP hospital visits for billing since January. We have only a list of patients at this point from HIM. It's being hinted at that the CEO wants us to bill his visits without his charge sheets. This concerns me, should it? I'm afraid that if he finds out that they've been billed he can challege the E/M levels, etc. He clearly has some issues and seems to be looking for trouble. Any suggestions from a compliance point of view?

  2. #2
    Columbia, MO
    No way I would charge without the documentation. But if you facility does his billing do you have access to his documentation for the encounters? You do not need his charge sheets if you have his documentation. He does not have any real recourse on the visit level if you used the appropirate guidelines and his visit documentation for the codes. However as I statd no documentation then no codes!

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    I would not enter charges without some kind of documentation. Without access to the records how would you know that he really saw them, just because he gives you a list of patients he is following that doesn't mean that he actually saw them that day (I've had one like that before). If you have access to the records then you could by the note. He should not have any recourse regarding the code if he won't be cooperative enough to let you know what he thought it should be in the first place.

  4. #4
    Phoenix, AZ
    You definitely cannot bill any of the encounters unless you have the notes. I agree with the advice given that you CAN code the visits without his charge sheets. You will need to stand your ground if management puts pressure on you to code without documentation. It will be VERY rough! If you (or any other coder) are/is asked to code without documentation, you will need to produce documentation guidelines from reliable sources (Medicare carriers, other large carriers in your region) to strenthen your stand. It's not an easy thing to do. The coding community is standing behind you!!
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  5. #5
    Default Been there done that...
    I've been in that situation and when he would finally give me his charges he wanted to bill for services he couldn't provide documentation for, i.e., the pt had already been discharged. Sorry no documentation no billing! However your facility should be able to pull the documentation from the list of patients you have, code out the services and bill for them. Like it was said before, as long as you follow the coding guidelines, there shouldn't been any problem.
    adrianne, cpc

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