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Incidental Procedure According to Provider

  1. #1
    Default Incidental Procedure According to Provider
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    I am quite frustrated and am hoping someone can put a little sunshine back into the reason I have been coding for over 10 years. Let me start at the beginning, I started at my current employement 2 years ago. When I found out that the providers were No Charging patients for billable services, according the providers financial concern for the patient or personal relationship with the patient, I explained to them that it wasn't legal and that they should not do that. They put up a fight, mainly because they feel they are losing the "power" to choose who and how they bill. I don't blame them, I get it, but I also don't make the rules. So, with resistance we made policy on this issue. Now, we have been having many patient complaints about wart destruction and the cost of 17110 and that the doctor didn't tell them it was going to be an extra charge or it only took the doctor 3 seconds to do etc. . Mind you, if the coding department sees that the provider performed a procedure but did not charge for it, the coding department will add the appropriate procedure to that day's charges accordingly. Is this wrong? Due to the complaints, the providers wants to be able to NC for procedures when they (the provider) believes their services don't warrant an additional code/charge other then the office visit, even if, according to the coders, the documentation supports a procedure code.

    Any thoughts or opinions on this. I want to do what's right lawfully but to be honest, I am so spent on fighting this battle. If a policy was written, stating the providers can NC what ever service they want but when they do the coding department is released of all liability and responsibilty in relation to the codes assigned to that particular date of service, would this really relieve the coding deparment of responsibility if we were audited?

    Anyone's opinion or insight is much appreciated.
    Last edited by Stefanie; 10-05-2010 at 01:51 PM.

    Stefanie Cramer, CPC
    Independent Contractor
    Medical Coding and Consulting
    Cramer Consulting

  2. #2
    Milwaukee WI
    Default Code correctly
    The provider should document what was done.
    The coder should code what was documented.

    By the way if you have a wart destruction, and that was the only reason for the visit, I would code the procedure and NOT code the visit.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    I totally agree. The complaints and issues are when patient is in for other reasons, mostly wellness and the provider puts a "little" dot of beetle juice on a wart. They want to be able to determine whether it should be billed or not be billed. Can they decided if their service meets the criteria of a code, if so, am I worried about nothing?

    Stefanie Cramer, CPC
    Independent Contractor
    Medical Coding and Consulting
    Cramer Consulting

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