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Thread: Coding Policy

  1. #1

    Default Coding Policy

    AAPC: Back to School
    Does anyone have a policy they would be willing to share on coding processes at their practice. Specifically I'm looking for who is responsible for doing the coding; who can chaneg codes; how questions are addressed etc. If so my email is Catherine@i1Consulting.com

    For example: the provider selects the diagnosis code. The coder confirms documentation supports the diagnosis and submits claim. If there is a question the coder queries the provider; only the provider can change/add/delete diagnosis codes....

    Also, can anyone point me in the right direction for an answer to the following question:
    A coder does not believe documentation supports the diagnosis selected by the provider. The coder queries the provider and the provider maintains that that is the diagnosis of the patient. The provider is the one that is legally responsible for the claim going out. Does the coder bill or not bill if she/he doesn't agree with the diagnosis selected by the provider?? What is the standard of practice?

    Thanks so much.

  2. #2

    Default Standard of Practice

    I was taught that if the documentation does not meet what the physician codes (i.e. documentation meets 99213 but NOT 99214), the coder MUST in ALL cases code to the documentation. It is your certification on the line as well as the physicians license. If audited the first person the auditor will come to is the coder, and "I did what the doctor told me to do" is NOT an acceptable defense.

  3. #3
    Join Date
    Apr 2007
    Hartford, CT


    I've found that most doctors are not familiar with the nuances of ICD coding. They use diagnoses interchangably because to them they are the same clinically. In my training with them I've found it helpful to bring the ICD book and actually show them the process of looking up the codes and how documentation can affect code choice. Then they can tell youwhat they mean when they document and if this always means the same thing you can incorporate it into your complaince (kind of like a cheat sheet). A for instance, myy cardiology doctors use SOB and DOE interchangably because to them clinically they were the same, but if you look them up in ICD you come up with different codes SOB=786.05 and DOE=786.09. They incorporated into our coding policy that no matter which one they used in their note they meant 786.05. This policy was sent with the note when we had an audit with no problem.

    My point is that sometime the docs need to be shown exactly how ICD works, and they need to be aware that what they dictate could lead to an entirely different diagnosis per ICD than what they were intendting.

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