LauraNewYork
Networker
Our practice has recently changed the method that claims are sent out. Currently the providers chose the level and the dx codes . Biannual auditing of the providers was put in place. Coders are not allowed to make changes to the submitted level or submitted dx codes. Coders add modifiers as needed. The coders have strenuously objected to the change, knowing that it would cause a lot of back end work.
As expected, we have seen a huge number of denials related to dx code errors. I just discovered that our EMR does not allow the providers to put the dx codes in a specified order, rather the codes are randomly applied to the charge. I have completed multiple searches regarding the legal repercussions of incorrect dx coding, but am having difficulty teasing out legal repercussions of incorrect dx coding as a separate issue from level or modifier coding. EXAMPLE: a charge went out with gastroenteritis as the primary code when the patient was actually seen for breast cancer. The breast cancer was the 5th listed code. Another charge went out with multiple R codes when they were seen for a cancer evaluation which wasn't even listed on the charge.
I would greatly appreciate any input regarding the legal repercussions of incorrect dx coding when billing level and modifier coding is correct.
As expected, we have seen a huge number of denials related to dx code errors. I just discovered that our EMR does not allow the providers to put the dx codes in a specified order, rather the codes are randomly applied to the charge. I have completed multiple searches regarding the legal repercussions of incorrect dx coding, but am having difficulty teasing out legal repercussions of incorrect dx coding as a separate issue from level or modifier coding. EXAMPLE: a charge went out with gastroenteritis as the primary code when the patient was actually seen for breast cancer. The breast cancer was the 5th listed code. Another charge went out with multiple R codes when they were seen for a cancer evaluation which wasn't even listed on the charge.
I would greatly appreciate any input regarding the legal repercussions of incorrect dx coding when billing level and modifier coding is correct.