Wiki Concerns about Certified Coding Compliance Officers reponse on an Email

[abwell30]

Hello everyone,

I am writing this post for advice on what I should do about an email from our Coding Compliance Officer in response to an email I sent a certified coder in our organization. I am a CPB and work billing Medicare and some Medicaid at my organization. I have sent the email to the CPC coder asking her to review a date of service where the patient was billed in error and had Medicaid. One of the reasons I needed her to look at it was the provider billed a new patient visit and the patient has been well established with our providers for the last year. I received a response from the Coding Compliance officer stating why was I asking the coder to review it when all I had to do was convert the new patient visit code to the "corresponding" established patient visit code. In my years in this industry and working with many facilities we as billers (who are not certified coders) where told to give those types of visits to the CPC personnel to review for correct coding. Am I wrong in this? and Should our Certified Coding Compliance Officer even be suggesting that I as a non certified coder just randomly change the codes? Thank you for your time in answering my question.

 

[pscanlan]

In the organizations that I've worked for (two third-party billing companies) the procedure you outlined - namely forwarding trouble cases to coders - was the established procedure. As a CPC, I still field these types of inquiries from coworkers almost every day.

In my opinion, the only people that should be assigning codes are coders. If you haven't gone through training or otherwise been taught coding decision making, it is very easy to make a mistake that will result in a denial. I have never - and would never - come down on a coworker for wanting a coder to look at a claim.

That said, every healthcare organization does things differently. If your group thinks that billers know enough coding to change codes, well I guess you just got some more responsibility without the expected rewards. All the work, none of the pay, as they say. I might perhaps pursue other management avenues to raise your concern. It's possible that your direct supervisor (or someone else - every office has it's guru) might have some insight as to why they're being snooty.

 

[Tamn2@comcast.net]

Compliance Billing Specialist

Good Morning,

I agree with your concerns about being told to change the code from a New patient to an Established patient unilaterally, especially as these codes do not map 1-1 due to different documentation requirements.

You should bring your concerns to your manager as this is an area (E&M coding) that is increasingly coming under scrutiny from not only Medicare but Commercial carriers as well for audits.


Tammy