Wiki Changing level of E/M

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diann

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I have a question regarding who can change the level of an E/M service. I know it is outside the scope of my certification. Here is the scenerio...a specialty provider comes to my clinic, our new management company and the specialty provider have apparently come to an agreement that we can change his levels of service if we disagree with the level. I have stated that that is outside of a coders scope of certification and that the provider needs to change the level and initial it--basically stating he is aware of the code change-- and was told I was wrong. If the new management person changes the code and initials the superbill, can I code this. I just want to be covered.

Thanks,
Diann DoBran COC, CPC
 
It actually is the responsibility of the coder, NOT the provider, to determine the E/M level. That is exactly what you are certified to do! The provider should only be documenting the clinical details of the visit, and leaving the determination of the level to the coder.

If the provider does "choose" a level, he is functioning outside the scope of HIS knowledge (unless he has undergone coding training), and a certified coder should, indeed check his codes for accuracy and change them as necessary. Remember that determination of E/M levels is not a clinical function, it is a coding function!
 
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Don't think of it as changingthe code because you are not. The provider guessed at what they thought the code should be and you confirm from the documentation provided what level of code it supports. Now if you send it back and say you are missing this and this element and need to redo the documentation and they change their note. That is changing the code.
 
I guess that is what I was meant by changing the code. I know what level the visit should be and than consult with the provider if there is a documentation issue in regards to the level. We had an auditor come in and said that it is ultimately the provider's responsibility to choose the level of service and than initial any changes, that I as a coder could not change any levels on my own (which I don't) and that the provider's initials are proof that he agreed to the new level. The new management company is saying we don't need his initials to change the code and that I can just change it.
Thank you for all your help
 
Only the physician can amend the medical record. Maybe that is what they are referring to? If the medical record only supports a level 3 you cant bill a 4 even if that's what the physician tells you it is.
 
I think there is a misunderstanding about what the auditor said. As CodingKing pointed out, it is true that the provider is the only one who can change the medical record; but the level is up to the coder to determine, not the provider.
 
I believe it is ultimately the providers responsibility to choose the level. After all, the charges are being billed out under his/her name and it is most likely they that will reap the repercussions if it is wrong.
That being said, you as a coder have specialized training in E/M coding and the physician obviously trusts your opinion, as they have given you expressed permission to "correct" the coding if they have chosen the wrong level.
I would have no problem under that scenario, correcting the E/M level to one that I felt was appropriate.

I hope this helps,
Terri
 
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