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Thread: non-certified coder

  1. #1
    Join Date
    Apr 2007

    Angry non-certified coder

    AAPC: Back to School
    I need some help. I am a cpc, I work in an office with another coder who is not certified, but has been coding for 20 yeeeeaaaarrrrsssss.

    I would really like to find a "job description", "responsibilities" of a coder.

    My co-worker continues to code and bill for whatever the Doc writes down on the superbill with no supporting documentation. She puts full responsibility on the doc, "he wrote it down". I tell her he is not a coder, that is what he hired you for.

    Do you know where I can find any info in black and white bold underlined writing that has the basic expectations of a coder.

    To me this is common sense, however, there are apparantly A LOT of people who don't get this.


  2. #2

    Default CPC title

    I would recommend that you dig up the info on CPCs and then CCS-Ps from teh two academies. The CPC says:
    1. Proficiency in adjudicating claims for accurate medical coding for diagnoses, procedures and services in physician-based settings
    2. Proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology, pathology and medicine
    3. Sound knowledge of medical coding rules and regulations including compliance and reimbursement. A trained medical coding professional can better handle issues such as medical necessity, claims denials, bundling issues and charge capture
    4. Knowing how to integrate medical coding and reimbursement rule changes into a practice's reimbursement processes
    5. Knowledge of anatomy, physiology and medical terminology necessary to correctly code provider diagnosis and services

    AHIMA's CCS says:

    CCSs are skilled in classifying medical data from patient records, generally in a hospital setting. These coding practitioners:

    Review patients’ records and assign numeric codes for each diagnosis and procedure
    Possess expertise in the ICD-9-CM and CPT coding systems
    Are knowledgeable about medical terminology, disease processes, and pharmacology.

    And then add in our code of ethics and you should be able to defend what you do and why she should pay attention. We bear the brunt of the responsibility though as certified coders as we are held to ahigher standard than non-certified ones do.

    Good luck!

  3. #3
    Join Date
    Apr 2007
    Kansas City, MO


    Sounds like she is a straight biller/data entry person and not a "coder" if she is just billing what the doctor says. So at this point, being non-certified, it may be that her job is "just to bill" what she is given...and if that is the case the doctor is ultimately responsible.
    Better make it clear with the docs and managers just what it is they think she should be doing. If they think she is checking on their coding, she is a big liability.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  4. #4
    Join Date
    Apr 2007


    Oh yes, they think she is the expert and she should be making sure it is correct, this is why they hired her.

    She does code, the only time this is a discussion or an issue is when I find an error on her part, then it's the doc's fault.

    Thank you all very much though.

  5. #5



    Try going to this link from AHIMA's website (guidelines for proper coding):


    And the CDC has this on their website:


    The AHIMA site is pretty informative with what they list.

    Hope this helps

    Heather MacPherson, LPN, CPC, CPC-H

  6. #6
    Join Date
    Apr 2007

    Default Thanks

    Thank you so much for these websites, I was looking for this information

  7. #7
    Join Date
    Apr 2007
    Sarasota FL

    Angry No documentation

    If your director won't do anything about it and thinks this is acceptable then he/she need to be fired, along with the idiot who is coding the procedures without documentation. Both are ultimately responsible/irresponsible for their actions. If the provider has given the go-ahead to allow this then there needs to be a disclaimer so he is ultimately responsible. In theory they could all go to jail for fraud... I won't be visiting them though. All us responsible coders do our very best to ensure everything we bill is documented. Certainly, all my fellow coders will do absolutely anything to ensure that all documentation is in place before being billed. If the provider won't document it, we don't bill it and he doesn't get paid for it... period. We insist all our coders are certified, and if they're not they have to get certified within 12 months of hiring. You should reiterate to your director the old coding saying, "if it's not documented it didn't happen" and get that moron who's billing these procedures to see if he understands what it means. Perhaps they've never heard the phrase or don't understand its significance.

  8. #8
    Join Date
    Apr 2007
    Milwaukee WI

    Default Maintain profesionalism

    Littlebit ...
    First, you weren't there and didn't witness, first-hand, the incident(s). Stay out of it. If it was NOT your job to review the account you had to no business looking into it (and doing so may have been a HIPAA violation). If your "friends" come to you to vent, tell them it's their responsibility to go to their supervisor if they feel fraud is being committed. You cannot testify to something you have not witnessed. I repeat ... stay out of it.

    Second, if you do note errors in coding or issues related to coding, report them, professionally and without emotion or recrimination, to your supervisor. It is your supervisor's responsibility to act on these issues and correct systematic errors. Keep a record of your memos to your supervisor alerting him/her to coding/compliance issues.

    Third ... and I am NOT being flippant. This seems like a toxic work environment. Start looking for another job.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  9. #9


    Thank you. I have all ready taken care of this situation over the past couple of days. I appreciate everyone's opinion.

  10. #10

    Smile The Doctor Does Have the Say ...


    I believe this should go two ways.

    If she is too big on the "Doctor says so," someone might want to make the doctor aware of her attitude.

    I used to work for a dermatologist ... and I was always suggesting things to the doctor and his 2 physician assistants. I increased his yearly income (in one year), from $360,000 to about $3,000,000.

    Making more money should always be on the minds of everyone in the office (effectiveness and efficiency). If this lady is simply "doing what the doctor said," then she may be missing some extra income for the doctor ... if she were simply putting a bit more thought into it.

    Everyone in the office should work as a team (her included) ...

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