Wiki CPC changing CPT to match documention

[tyrunyan1974@gmail.com]

I am wondering if anyone has found anything in writing that states, a certified coder is able to change a CPT code so that it reflects the documentation without informing the physician every single time.

I have recently started working for a facility that currently stops coding and goes to seek out the physician to change the CPT code. This seems a little crazy to me since we are hired with the credentials and certification so that we can help make sure claims go out with the correct coding that is supported by the documentation. The last facility I worked for the physicians were more focused on the patient than the coding of the CPT, therefore if their note did not support a 99214 but did support 99212 it was changed on the back end by the CPC before being sent to the insurance company and vice versa.

Please help so that I may be able to help make things streamlined for my new employer.

 

[CodingKing]

There is no law stating who can and or cant change the CPT code. So there is nothing in writing to refer to. It will be up to your company policy.

 

[tyrunyan1974@gmail.com]

thank you

I figured as much but wanted to double check before we went into creating a policy.

 

[Chelle-Lynn]

Remember that all coding ultimately is the providers responsibility and affects their license and financial well being. It is not unusual for a provider office or facility to seek the providers approval for coding changes even when the recommendation is coming from a certified coder or auditor.

 

[BDunham7]

Brenda Dunham, CPC

We recently researched this question and concluded that it depended on whether the CPT code was included in the provider's note, or was recorded by the provider outside of the note. If the CPT is part of the note itself, then any change would be an amendment to the medical record and would require the provider's approval and signature.