I have been a coder for many years. It has always been set up in all the places I have worked and up until 5 months ago, that charges are reviewed for accurate coding PRIOR to sending the claim out the door. Our coding team, and all the coders I currently know have been trained to take words in the documentation and translate that into CPT, ICD-10, and HCPCS. To us, this is how coding works.
Recently, our coding department has went through a change initiated by Senior Leadership/CFO to change our work flow from reviewing charges prior to release to the following:
1. All providers will choose E&M level that they feel is accurate to the visit.
2. All providers will choose their own ICD 10 codes.
3. Coders are to only review the accurate provider names on the notes,(because the names are never correct); make sure a mod 25 can be applied (if a provider adds one onto the charge, we are NOT to remove it)
4. Coders will correct all the E&M/Dx related code denials after charges have been sent and denials are received OR if it is caught on the back end scrubber.
5. Coders will do a monthly "audit" of 5-10 charts that is done twice a year. All things found will be shared with the provider that was audited.
We have been told that the providers feel it is not a coder's job to "assign" a patient a diagnosis, while we have tried to explain that our role as coder's is to simply match the documentation that is provided to us, we are not changing the actual diagnosis that a provider has given to the patient, only matching what is in the documentation. (We never touch the documentation,we know better, this is simply regarding the ICD10 codes).
We have run into a whole host of issues with this new initiative/job duties.
1. The providers are pulling over icd10 for issues that are not even relevant to the visit i.e. patient was seen for lung cancer and has a icd10 of MI on the superbill and not the lung cancer ICD 10. (We are not allowed to change this, we must send it through) We are encouraged to educate the providers on choosing the correct ICD 10. While this sounds good in theory, in their screen, they cannot "update" or rearrange codes like we can in our superbill screen.
2. ICD 10 codes are coming across that cannot be billed together i.e. excludes codes, unspecified codes, two anemias, ect and thus prompting a huge amount of denials. This is because the providers simply do not know all the many, many rules involved in the coding process.
3. Our denials have went up due to charges not being reviewed by coders prior to release.
We have been told that this is the norm for other practices and that this is how they utilize their coder's. So I am here, trying to find other coders that are doing a reverse process like outlined above. Is there anyone else doing it like this? If so, how is your work flow set up. If not, your input would greatly be appreciated. Job descriptions of what others coders ARE doing on the daily basis would also be very helpful as we are trying to go through this change a little more smoothly and find some suggestions.
Thanks so much!
Recently, our coding department has went through a change initiated by Senior Leadership/CFO to change our work flow from reviewing charges prior to release to the following:
1. All providers will choose E&M level that they feel is accurate to the visit.
2. All providers will choose their own ICD 10 codes.
3. Coders are to only review the accurate provider names on the notes,(because the names are never correct); make sure a mod 25 can be applied (if a provider adds one onto the charge, we are NOT to remove it)
4. Coders will correct all the E&M/Dx related code denials after charges have been sent and denials are received OR if it is caught on the back end scrubber.
5. Coders will do a monthly "audit" of 5-10 charts that is done twice a year. All things found will be shared with the provider that was audited.
We have been told that the providers feel it is not a coder's job to "assign" a patient a diagnosis, while we have tried to explain that our role as coder's is to simply match the documentation that is provided to us, we are not changing the actual diagnosis that a provider has given to the patient, only matching what is in the documentation. (We never touch the documentation,we know better, this is simply regarding the ICD10 codes).
We have run into a whole host of issues with this new initiative/job duties.
1. The providers are pulling over icd10 for issues that are not even relevant to the visit i.e. patient was seen for lung cancer and has a icd10 of MI on the superbill and not the lung cancer ICD 10. (We are not allowed to change this, we must send it through) We are encouraged to educate the providers on choosing the correct ICD 10. While this sounds good in theory, in their screen, they cannot "update" or rearrange codes like we can in our superbill screen.
2. ICD 10 codes are coming across that cannot be billed together i.e. excludes codes, unspecified codes, two anemias, ect and thus prompting a huge amount of denials. This is because the providers simply do not know all the many, many rules involved in the coding process.
3. Our denials have went up due to charges not being reviewed by coders prior to release.
We have been told that this is the norm for other practices and that this is how they utilize their coder's. So I am here, trying to find other coders that are doing a reverse process like outlined above. Is there anyone else doing it like this? If so, how is your work flow set up. If not, your input would greatly be appreciated. Job descriptions of what others coders ARE doing on the daily basis would also be very helpful as we are trying to go through this change a little more smoothly and find some suggestions.
Thanks so much!