# Cpc changing physician codes



## chrissyr (Jan 12, 2013)

I have always been under the impression that the AAPC specifically prohibits coders from changing physician's codes with or without their permission.  But I can't seem to find any information on it.  I would appreciate any help I can get.
Thanks!


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## mitchellde (Jan 12, 2013)

No there is no prohibition.  A coder always codes from the providers documentation regardless of the codes selected by the provider.  A coder may change the code the provider selected but may not change the diagnosis nor select any code not supported by the documentation.


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## Sueedwards (Jan 14, 2013)

Debra, thank you for this information, I too have spent much time in searching for this in documentations and came up empty handed.  

Thanks, Susan


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## chrissyr (Jan 14, 2013)

Thanks Debra. Do you know where I could find documentation that supports your answer? Not that I doubt you, but I am curious because my employer's legal department has always fought it (saying we could not change the codes).  But now I am under a new manager and I'm being told it is okay to change the codes. However, she was clueless when I questioned how she got our legal department to change their minds (meaning she hadn't dealt with our legal dept). So now I am worried about myself legally. I have gotten answers that contradict each other and would like to form my own opinion based on documentation that I find. Hope this makes sense.


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## sharynwolfe (Feb 28, 2013)

So then my question to this would be - is it only a coder that can change the code or can a biller change the codes to what the documentation reads?
Thank you,
Sharyn


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## kevbshields (Mar 1, 2013)

I am only vaguely familiar with references to certified coders being employed for the sole purpose of supporting compliance--I know this was mentioned years ago in relation to hospital compliance plans.  However, if you read most job descriptions for physician coders, it requires them to make changes.

Internal policy dictates whether or not a coder may change something a physician has selected.  Certainly we cannot change record content, but codes are not really parts of the record.  Point being, some practices are content with the error rate their physicians produce and others (in my opinion more compliance-minded) do not let providers choose any codes, relying on full record abstraction, meaning the coder has autonomy to determine the claim's content.

As for billers changing codes, there are a lot of variables and considerations there.  First, billers might have to "change" or crosswalk codes based on contract stipulations.  In some places the coders know this; in others the billers have that responsibility.  Too, there is the consideration of what triggers the change.  Is it that the biller changes codes to get paid, because that is out of line with separation of duties and is a non-compliant practice?  On the other hand, if the biller is abiding by published rules, then that may be acceptable.  As a credentialed coder, I hesitate to encourage billers to make changes to the coding.  If, however, I'm working with an experienced biller, or one who is certified in a relevant area, then I'd be more comfortable.  The problem is that a great deal of bad habits have not been snuffed out of the billing side of the house, primarily because we don't require them to be credentialed (many, many times).  Usually, I prefer for the coders to make changes; it keeps the division of responsibility clearer.

This is still going to be determined by internal policy.  I cannot fathom that CMS or OIG have any real standards on who can do what in your practice.  If that were the case, we'd have a lot of practices fined in short order.


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## mitchellde (Mar 1, 2013)

I agree with Kevin but I would point out that no matter who is changing the codes it must always be done with the complete documentation being the driving force behind the change.  I am not sure what you mean Kevin by contract stipulations being behind the change.  You can not use a dx code that the patient does not have per the documentation.  And you cannot charge a procedure or service not documented.  Now if you mean that for some CPT odes there are duplicate HCPC II codes then yes, for Mcare the biller can change the CPT code to its duplicate HCPC II code.


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## sharynwolfe (Mar 1, 2013)

Thank you both for your responses, I think this just encourages us to take a look into our internal policies. Documentation has always been our driving force, I am just a very "by the book" person. I recall being taught in class that "DX is law" therefore I worried about my billers changing codes without consulting the physician first, even if they are changing it to what the documentation shows. 

Debra, what I think Kevin meant by contract stipulations would fall more under CPT codes. For example if the physician choose a consult code for a medicare patient, that would obviously need changed to a non consult code.

Thank you both again!
Sharyn Wolfe, CPC (still a newbie)


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## kevbshields (Mar 2, 2013)

Debra, what I meant by contract stipulations are those annoying little variances like a certain insurance company not accepting a specific CPT code, or a recent recommendation I discovered (per a student) on a Medicare LCD.  These are written recommendations that guide the provider to bill or code in a specific, sanctioned manner.

I could go on for days about those stipulations included in VA contracts, but likely the providers and their staff who sign don't bother to read them.

I'm pretty certain that my post made clear my discomfort with changes not based on record reviews or contents.


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## mitchellde (Mar 2, 2013)

I understand but, at no time can the codes differ from the documentation for diagnosis or procedures.


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## annettesofly@yahoo.com (Jul 31, 2014)

*Coder selecting level of Care*

I am having this same issue.  I would someone to give me some feedback on where I can find the guide lines on rather a CPC can select the Level of Care for the Provider and to what degree without the provider consent or agreement.  any help is appericated


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