Does it matter that the coding order in EMR does not match what is billed out to insurance? Obviously as a coder I know that you want to code to the highest level of specificity. My doctor is trying to keep from dealing with EMR software tech to have it all reworked to get it placed in the order needed. My answer was yes. What are your thoughts? Thanks in advance!
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Wiki Coding Order
- Thread starter rbann7
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mitchellde
True Blue
No it does not matter what codes or in what order the provider or EMR put them. They codes on the claim can be different than the codes selected in the EMR as long as they match the documented rendered diagnosis and the order they go on the claim must adhere to correct coding guidelines but it does not have to match the order in the chart note. As far as CPT code order. We usually list the E&M first and that s just because it is how it has always been listed, after that we list any procedure in the order of the RVU value but make sure the modifiers are where they need to be and that is not always on the lower RVU service.
mitchellde
True Blue
As far as DX order it does not matter again how the EMR lists this. The coding guidelines and the conventions in the code book will assist you in how to list the codes. Some codes in the book are first listed only allowed and others are secondary only allowed. As a coder it is your place to know which codes go in which location on the claim. We do not expect the providers to know this and certainly the EMR cannot be depended on to get this correct.
Cynthia Hughes
Expert
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diagnosis order
Hi,
One additional thought about the diagnosis order. It is important that your EMR is capturing the diagnoses for each encounter as diagnostic statements and not merely as codes. I have heard from some that their EMR does not capture the typical assessment and plan format where the physician lists each diagnosis or presenting sign/symptom with descriptions (acute, chronic, probable) and instead requires selection of codes for each diagnosis. AHA Coding Clinic (first quarter 2012) has specifically stated that this is not okay.
The documented diagnoses should be listed in order of importance as the reasons for services provided at the encounter and the codes are reported on the claim in that order with exceptions for compliance with ICD-10-CM instructions (e.g., code first, code also).
I hope that makes sense and is helpful.
Cindy
Hi,
One additional thought about the diagnosis order. It is important that your EMR is capturing the diagnoses for each encounter as diagnostic statements and not merely as codes. I have heard from some that their EMR does not capture the typical assessment and plan format where the physician lists each diagnosis or presenting sign/symptom with descriptions (acute, chronic, probable) and instead requires selection of codes for each diagnosis. AHA Coding Clinic (first quarter 2012) has specifically stated that this is not okay.
The documented diagnoses should be listed in order of importance as the reasons for services provided at the encounter and the codes are reported on the claim in that order with exceptions for compliance with ICD-10-CM instructions (e.g., code first, code also).
I hope that makes sense and is helpful.
Cindy