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To Wait or Not To Wait

  1. Default To Wait or Not To Wait
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    Hello everybody.

    Does anyone know if there is a specific written rule that says we must wait for the operative report before a surgical claim goes out the door? Our physicians do their own surgical coding. Should our coders just leave it up to the physician and not wait to see what the actual documentation says before sending out a claim?

    Would appreciate any official references for yay or nay.

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    I would NEVER send a claim for something that I couldn't prove happened.

    ~L
    CPC, CGSC, COSC

  3. #3
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    I never send out a claim for a surgery unless I have an operative note. Imagine getting audited and there is no note for any number of reasons - doctor forgot, dictation done but recording is not clear, dictation put in wrong chart, etc. If we are still missing dictation after a week we inform the doctor so he can redictate- hard to do that six months to year down the road.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  4. #4
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    I have several physicians who do their own coding, I wait on the OP report. I code it and then compare it to their codes to make sure we are all on the same page. I have caught several errors doing this. On both sides of the fence. It's a really good double check system and it helps me to understand what they say and what they mean. If there is a discrepancy, I send it back for clarification. But, I do not bill anything without the OP report.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

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    Quote Originally Posted by scorrado View Post
    I never send out a claim for a surgery unless I have an operative note. Imagine getting audited and there is no note for any number of reasons - doctor forgot, dictation done but recording is not clear, dictation put in wrong chart, etc. If we are still missing dictation after a week we inform the doctor so he can redictate- hard to do that six months to year down the road.

    That's what I keep telling "them". It makes no sense to me to have denials, appeals, rework accounts, exposure to potential audits, medical-legal issues, etc. just to get a claim out a day or two faster.

    Somehow "they" want to see something in writing that says we have to hold the claim. Otherwise, send it out as coded by the doctor.

    It's insane and I really don't want to have to prove that I'm right. It's like don't cross the street if you see a car is coming and will probably hit you. Do you have to have a written rule for that?

    Thanks.

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    Quote Originally Posted by Anna Weaver View Post
    I have several physicians who do their own coding, I wait on the OP report. I code it and then compare it to their codes to make sure we are all on the same page. I have caught several errors doing this. On both sides of the fence. It's a really good double check system and it helps me to understand what they say and what they mean. If there is a discrepancy, I send it back for clarification. But, I do not bill anything without the OP report.
    Exactly. Thank you Anna.

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    Quote Originally Posted by Treetoad View Post
    I would NEVER send a claim for something that I couldn't prove happened.
    My feelings too. I think there's a big world of difference between coders and our training and ethics and those who just want to bring in the money faster and don't think about all the repercussions.

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