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Thread: Legality of choosing CPT codes.

  1. #1
    Join Date
    Apr 2007
    Quincy, MA

    Default Legality of choosing CPT codes.

    AAPC: Back to School
    This may be a silly question (I think it is) but some providers in my practice have been told that ONLY a provider can choose the CPT codes to be billed on a claim.

    Is it true that it is illegal for a Medical coder to select the appropriate E/M or CPT codes that go along with what is documented in a medical record?

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default What's the definition of "legally"?

    The physician is legally responsible if there are any findings of fraud in claims submission.
    That is NOT the same thing as the physician being legally required to choose the code him/herself.

    Consider this ... the taxpayer is legally responsible for paying his/her taxes. Doesn't mean s/he has to fill out the forms him/herself (lots of CPA's would be out of business!).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3


    Another thing, if it was illegal for coders to choose the codes instead of the physicians, all physicians would have to be coders, and us "just coders" would not be needed. And that would be sad!

  4. #4
    Join Date
    Apr 2007
    Idaho Falls, Idaho


    Very sad!
    Tesja Erickson, CPC, CPMA COBGC, CEMC
    The Coding Surgeon
    Medical Documentation & Coding Consultant
    2012 AAPC Idaho Falls Chapter President
    2011 AAPC Idaho Falls Chapter President-Elect

  5. #5

    Question Legality of coding

    This is a HUGE PROBLEM where I am working, the Doc's insist that only they can provide the codes, does anyone have any more thoughts on this and if so do you know where I can print out information that confirms the Coders right (as it may be) to apply the codes? Any help would be very much appreciated.

    Last edited by kiku3@ptd.net; 10-21-2011 at 06:04 AM.

  6. #6

    Default no ethics

    Hi friends,

    Me too sailing in same boat.Our EMR does not lock automatically after a file is finished.SO,when he finds out low levels like 99202,he adds some more elemnts for history or anything of his choice and insists me EMR is for convinence and he has everyright to do changes to get higher levels.


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