Practice Management Alert

Question: I work in a general and laparoscopic surgeon's office. When he assists other surgeons we obtain the billing information from the other surgeon's coders to bill as the assist.

Sometimes there is incorrect billing pertaining to the CPT codes and ICD-9 codes billed, according to the documentation from the operative report. There is contact made to have them verify and correct, but it is not always followed through with by the lead surgeon's office.

In effort to get the claim submitted in a timely matter I have submitted the claim for my doctor as the assist. I have done it in two ways: 1) submitted as billed by the lead surgeon, making notes on the account for the errors/problems and 2) submitting the claim with the correct billing information.

What is the correct way to handle this problem?

New York Subscriber

Answer: You should never knowingly send in the wrong codes just to get paid. That is a clear coding and compliance violation.

Your practice of contacting the other surgeon's coder and trying to explain why you will be submitting different coding is a good start. If they don't agree or follow through with the proper coding, however, you should still submit the codes you believe are correct.

"I encountered this all of the time when I had my billing company," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPCH, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. "I, like the writer, would contact the primary surgeon and tell them that they coded the case incorrectly and tell them how it should be coded and why. They would not want to listen to me ... they submitted it their way. But I would not submit the coding wrong for my doctor. That is a compliance violation," she adds.

Tip: Send an email to the lead surgeon's practice explaining the codes you will be submitting and why. This ensures you have your contact with the other coder in writing, and shows you informed them that you intended to submit different codes.

You won't likely know what the other surgeon ends up submitting or if they get paid -- but it's not really your concern, Cobuzzi explains. As long as you are compliant and bringing in the reimbursement your surgeon deserves, you're doing your job correctly.

Warning: Getting paid might be a bit more challenging when the other surgeon is submitting different codes. You may need to appeal a denial that comes from the surgeons submitting different codes, but during the appeal process if your coding is correct you should get paid.

"We got paid," Cobuzzi says. "Not always the first pass, sometimes it required sending in the documentation with an appeal. I would appeal with my documentation and show that my coding was correct."

Bottom line: You should always code correctly and avoid knowingly submitting an incorrect claim just to match the other surgeon's billing. "If you think about it, when there is an assistant surgeon, there are three sets of codes the payer gets: the primary surgeon, the assistant surgeon, and the facility and not all three are always in sync," Cobuzzi says. "Facilities and surgeons don't discuss the coding and work together to make sure they have the same outcome. Each independently codes the case. Why shouldn't the assistant surgeon do the same, in particular if they have a highly qualified coder."