Wiki code corrections and modifiers

[cwater]

Ultimately the physician is responsible for codes, modifiers and diagnosis that are submitted on a claim.

I am looking for information on what a certified coder can do vs. a non certified medical biller.
Can a medical biller who is not certified add a modifier to a claim or must this be done by a certified coder?
Can a medical biller without certification update information on a claim or must it be a certified coder and what documentation is required to be kept on file?

Any information about the support staff for the provider relating to medical billing in the Pennsylvania regarding what the support person is able to do if they are certified vs. non certified would be appreciated.

Thanks,
Camille Waterhouse, CPC

 

[mitchellde]

The coder is equally responsible for the codes submitted on the claim. At present there are no rules as to who the coder must be, so be that biller, or coder it does not matter. however regardless of who assigns the code to the claim, the code must match the documentation for the encounter. Therefore no codes should be assigned unless the documentation is reviewed.

 

[cwater]

Thanks for the input.

Does the coder or biller need to be certified? Is there any publications to support whether the coder or biller has to be certified?

Thanks,
Camille Waterhouse, CPC

 

[mitchellde]

In most states there is currently no law indicating that the one that codes the claim must possess a certification. There is no federal ruling on this either. This could change in time. The AHA stated that coding is to be performed by professionally trained coding staff, that is the strongest statement I have read. (1st quarter coding clinic 2012)