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The Work of a Coder: Survey Comments

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I believe that my company does not understand the ethics behind coding. I believe it is so important to have coders understand there responsibility regarding ethics. I've told my doctors if we do it correctly we will inevitably correct what's wrong. Being a CPC is a reward to me and I love what I do and am greatful to have AAPC as a support of what I stand for.

Our doctors code their own E/M visits for office and hospital visits and most do not dictate a note that matches the level of service charged. We do not have a coder in the insurance follow-up department. So a coder does not see or have any knowledge about denials.

Unfortunately, physicians in my area are very stubborn regarding respect for compliance according to coding rules. It is extremely frustrating, especially because based on courses I've spent money on myself, state we are to report incorrect coding practices. Yet if we do, we get blackballed and are out of a job. I am seriously considering changing career.

I disagree with and refuse to code in certain situations such as: If the script states osteoporisis and the dexa scan has negative results per the medical report, other coders will code 733.90 per script. There are other simular situations where the script is used for coding if it's allowed/payable.

As a CPC for this cardiology group of 6 physicians, my work is extremely challenging and diversified. We have created a compliance pPlan for coding and the ongoing education for our providers is key to selecting the most appropriate E&M codes as well as to understand the basic theory of coding.

Dealing with the insurance companies on how coding is suppose to be -- not how they pay. Commerical insurance companies don't know the rules for modifiers and documention with supposting ICD-9 codes on muliple charges. The just don't follow the coding guidelines rules, there system edits deny charges and prolong for payment for stupid reasons- like units don't support this service.(like office charge)

I have witnessed, through my experience, that most physicians I have worked with do not have the time to devote to coding specificity. Even those who are interested in learning coding usually fall back into old habits and prefer "cheat sheets" especially for E&M coding. Old habits often include using the same codes over & over again, and basing visit levels on "time." Diagnosis codes are usually repeated as well, such as 250.00 even though the patient may be uncontrolled or have manifestations of the disease.

I mostly work doing medical office billing and coding consulting when the offices have big problems that need to be fixed. I get to charge quite a bit for this service and I am in total control of my hours and what I do, usually I end up just educating their current, untrained employees about the importance of correct coding and how to do coding in general. I also help them clean up the mess that they have gotten themselves into. I feel that most physicians in my area do not place the necessary priority to having correctly trained staff until they find that there is a problem. It would make it better all the way around if physicians would hire the properly trained employees to begin with.

We are on an electronic medical records. Even though the providers do code their daily visits it is always reviewed with a coding staff. That feedback of incorrect coding is provided to the provider then. Yearly I also educate all of our residents regarding coding and compliance as well. This has helped the residents when they get out into practice on their own. Our coding staff is located in the same area as our providers and daily they all interact with each other.

I am currently working for a HIM staffing company and this is the first practice I have been assigned to. The edcuation of coding for some of the doctors have been slim to none and that is why I was called to this assignment. I have 5 years of surgery related coding to provide more knowledge and education to this almost rural small town hospital regarding the specialty I am experienced in. Some of the questions were difficult for me because I am a hired contract worker here.

I am a government follow up representative. Trouble shooting for denied accounts. I would like to obtain a position in coding, hopefully soon.

I feel that my employer should only accept AAPC certified coders. On the first day of my job with this employer, the amount of coding errors found was deeply disturbing. The coder responsible held a license from a six week coding course. The errors would result in thousands in refunds to payers. The errors would have been avoided simply by reading the guidelines in the CPT manual. I feel that my employer now has a new respect for the AAPC certified coder but still accepts any form of coding license! The company does hold the coder responsible to report any unethical coding and compliance issues. As an AACP Certified coder, I agree. So when my manager would not change certain coding practices I reported the issue as I've been instructed. The issue is now compliant but the retaliation from this manager is to treat me as untrustworthy and not a team player. I would not change a thing, as I know I did the right thing. My point is, the pressure for a coder to do the right thing can be very hard. I've had doctors, managers billers, administrators, techs, and all forms of staff challenge my coding and documentation advice. These people cn be very intimidating...especially an angry MD! I'd love to see an article on the stories of other coders and some advice from the AAPC on this issue. Til then, I'll keep standing my ground!

As a Compliance Manager you see a variety of coding strategies in the academic environment. Both providers and coding specialist put forth an effort to comply with the federal guidelines. However providers (MD/NPP) become frustrated with the documentation and education requirements. However because of the limited number of experienced coding specialist to assume more of the coding responsiblities for the physicians, the physicians concentrate on their clinical obligations and coding.

I believe there is a conflict in regards to correct/accurate coding versus insurance reimbursement. I have explained to my employer the misuse of modifiers.

Not all diagnoses/codes are on the pick list and the providers do not code those diagnoses which they write. Unfortunately, some of the employees required to code the diagnoses do not have a knowledge of coding and I fear that diagnoses are submitted incorrectly.

I don't believe accuracy and coding errors will be eliminated in our practice because the doctors are not available to you. Everything in our practice must go through the administrator and she has no formal coding education or background so I not sure how much of the information is being received by the providers or how correct that information is.

My providers sincerely think they understand coding and reimbursement. They want me to submit accurate and appropriate claims. They feel that they do not have enough time to document in the manner in which I suggest. I feel that I leave a significant amount of money "on the table" due to the lack of documentation and that frustrates me.

The majority of our work comes CPT coded, except pap smears. We are expected to code using only ICD9. Measures are being taken to improve upon providers giving complete and accurate information through physician training to lessen the use of "NOS" codes.

In our office, we handle everything from the time the claim goes to the insurance company until the claim is paid correctly. The office don't seem to really care if things are correct--they know that the billing office will fix it or correct it so hopefully the claim will be paid.

In my opinion physicians should be required to attend some type of coding documentation classes

It is very pleasant to work here. The only thing I disagree with is that the Coder that is not Certified overseeing the ICD-9 pick list and I don't always agree with the way she has entered to codes into the pick list. I am the Certified Coder and when I question things I always refer to the guidelines to see if the code is appropriate and I don't feel like my coworker does.

My work environment is not at all well supported by the physicians that work here. They do not want to document as needed to be within compliance. They need a good wake up call, such as if you don't document you don't get a paycheck or something of that nature, but we get no support from administration

Most of my coding and work experience has been in surgical coding for private practices. However now I work for an occ med clinic and the rules for workers comp are very different from the private side. I find it difficult to convince our providers and management that the overall coding process is still the same. That just because we do not participate with Medicare, Medicaid or private traditional insurance carriers doesn't mean we do not have to follow the coding rules. It's a constant struggle.

In the DoD Army sector, the physician has to code his note because we have an EHR, in which, the coding is "locked" into the note, and is considered part of the physician's legal note.

I work for 14 doctor 6 PT, and 2PA practice. I am the only CPC. I manage the insurance department(15) and do the compliance for the entire office. I wrote the policies and procedures for the entire practice. My department looks at every charge before it leave our office to go to the insurance company for accuracy. The providers here are very good at charging what they do both in the office and in surgery. We keep up with CCI and insurance billing rules daily. Compliance is a very important part of our daily work

My work enviroment is frustrating. The physicians I work with want accurate coding and higher reimbursement, but when I try to suggest ways we can improve, we constantly butt heads because they want to do things their way. Whne I try to point out that many of their pracgtices lead to non-compliance they state that this is their problem and not mine, I would never be held responsible for things I am told to do by them. At the same time, they insist that I get the office compliant.

My manager has a coding background, but not a substantial enough voice to prevent coding staff from being put into a compromising situations. The coding dept is under finance which I think is a big mistake because you find upper management wanting us to code for reimbursement instead of for compliance and accuracy and because of that we often get into uncomfortable situations.

We have no compliance program in place. I am considered "negative" and not a team player because I suggest compliance frequently. My direct supervisor specifically states, "Just slap the codes on the tickets" and does not provide or encourage ANY type of auditing, even of the physicians that have access to the EMR. The EMR allows the physicians to choose level 4 charges for a diagnoses of acute sinusitus alone!! I worry about my credentials.

I love being a coder, but the practices that my employer has picked up has me scared. I have reported some things to our Compliance office and was told he would look into it. As of now nothing has been done. My practice is trying very hard to not have a coding department. They just elminated 6 postions, and in three months are looking at doing more. They think the physcian's can do the coding and they do not need us. We have to prove on a daily bases why they should keep us. They do not give us any education any more, and now we are doing more clerical work than coding.

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