Practice Management Alert

Question: We have one doctor who marks multiple procedure and diagnosis codes, but doesn't sequence the diagnoses numerically or indicate the corresponding procedure codes. I've been told that from a coding compliance perspective, billers aren't allowed to conduct assignment of code to procedure, even if it's obvious. I've been told that only a doctor can make changes to a fee ticket (e.g., change to procedure code, diagnosis code, etc.), and that the ticket needs to be signed, marked as a change and kept on file. Is this true?
                                       
Florida Subscriber

Answer: Probably not. Unless your state law says otherwise, which is unlikely, the decision about who can make changes to a fee ticket is an "institutional call," says consultant Quin Buechner, MS, M.Div, CPC, president of ProActive Consultants in Cumberland, Wis.
 
In fact, you don't even need to have the physician sign the fee slip. The idea that a physician must change a charge ticket is a hold-over from the days when practices gave the slip to the patient to file with the payer, Buechner recalls. "Things have changed in the last 20 years," he quips. Of course, if your practice wants to have the physicians sign the charge ticket, go ahead and have them sign away.
 
Also up for grabs is who can make changes to a code on the charge ticket, Buechner says. Again, this is a policy call your practice can make for itself, depending on how coding-savvy your billers are. "No law exists that really rules on that topic," he notes. "It is true that the physician is ultimately responsible for a charge, but it is up to the practice to decide who can or cannot change the code."

"Many practices allow the coders/billers to code or change a code from the chart or other documentation," Buechner continues. "If the coder changes a code based on documentation, the change can be entered on the fee slip and you can track that if there is a question."
 
As for connecting diagnosis codes with procedure codes, that again is a policy decision your practice should make. But be careful here, warns Buechner. "Tying diagnosis to procedure can be problematic" and it's probably best to send the ticket back to the physician for clarification, he counsels.
 From a compliance perspective, it might be beneficial to establish a policy that requires these changes to go through a physician.
 
One tip to keep in mind at all times: Your charge ticket should "accurately report" everything that was done and documented, Buechner reminds practices. Remember that in the government's eyes, if it wasn't documented, it wasn't done. And if your charge ticket isn't 100-percent accurate, "you have a fraud and abuse problem," Buechner concludes.