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Thread: The Future of the Medical Practice

  1. #1

    Default The Future of the Medical Practice

    In my company we have been having a consulting firm coming in to inform us on some changes our practice/hospital is going to have to make within the next 3 years. I guess I am confused and would like to find some additional information.
    In one part of this meeting we discussed how the physican will have to code all their own work , the E/M, the Procedures ( if any done ) and the diagnosis coding. I completely understand the E/M and procedures but I can tell you from my experience there is NOOOOOO WAAAAYYY all our doctors is going to know how to do anything with diagnosis. In fact they are very vocal to the administration that, "This is the coders job, not my job."
    I asked, " Will we be able to change the diagnosis codes if the doctor used the incorrect codes?" The consultant acted like there was no way we could change the diagnosis without actually consulting the physican before we change it to the correct code. My question is...why in the world would we not be able to change it to the correct diagnosis code without the Dr granting me his permission? The doctor has no clue about the diagnosis codes and they will admit they dont. Granted, some of my doctors are decent with diagnosis coding but dont know all the coding rules for this and that.
    Is this true this is a government mandated thing where the dr is going to have to do all this own coding including the diagnosis codes? This makes me question if they are even going to need me in the future for my job? Is a computer going to do my job for me?

    Any thoughts?

  2. #2
    Join Date
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    Default

    this is not a government mandate. It is how this vendor has created this particular software, or how this consultant feels things should be done, but only if your office agrees that this is the best way. If you thing getting the correct dx code is hard with ICD-9 CM, then wait for ICD-10 CM! While it is not hard to learn, ICD-10 CM has some particular quirks that requires close attention. There is no way the computer can pick the correct code given the number of choices and the way the providers word the diagnosis and the procedures. A coder may change any dx code submitted by the provider as long as the providers documentation and coding guidelines are being used for code selection.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Default

    Debra

    That is exactly what I was thinking...that it was a vendor thing. He kept saying that the government is mandating this 2015. However, havent really read too much else into this. I really dont feel , especially if I know for a fact that the code is incorrect , that it is appropriate for me to inquire a physican every time he has coded something incorrectly.
    The consultant also said something about being SNO MED codes built in the system. Again, this goes back to the fact that it is a doctor/nurse choosing a code not a trained certified coder. I feel this company is trying to pull a fast one over on us, but there is no one there that would listen to my opinion on that.
    Thanks for the input.

    Val

  4. #4

    Default

    They probably are not trying to pull a fast one on you. What I have found is that trainers simply don't have the answers for everything the software forces a provider to do, in this case have the physician code, and they pull an answer from no where. Good trainers will tell you that plain and simple they don't have an answer, it's just the way the software works.

    Our practice works like this and as far as I know, always have. I don't see claims until there is a denial or other problem, so I have made it my business to run reports on codes, audit documentation on a regular basis, and educate my doctors and medical assistants so they understand when the codes change and what they should be doing.

    The good thing is, everyone I work with is incredibly open to education.

    Depending upon the situation, it wouldn't be necessary for you to query them on everything. For example, we have one physician who is constantly leaving the fifth digit off of a code, the good thing is that all I have to do is check the documentation to determine if it is a basal or squamous cell skin cancer. However, outside of that, we absolutely do go back to our physicians to ensure we are changing the code correctly.

  5. #5

    Default

    One key point is to remember that it is a vendor that is offering this information. They are trying to sell a product. I believe this is why it is vitally important that coders be so actively involved in the selection process. I also agree with you in that you should not have to query a physician for each incorrect code. This can be time consuming and frustrating for both the physician and the coder, as well as costly to the practice.
    Last edited by kjscoder812; 11-04-2012 at 11:25 AM.

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