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AmandaW

AmandaW

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What if the doctor wants you to code something a certain way that you know is really not right...a lot of times, it's a gray area, but not always...sometimes it's just not right. As a CPC, would I be ok if we were audited? Who's head is it on? Mine as the CPC or the doc? And if it's MINE, then would putting a note in our system stateing " Per Dr. X, the dx that is going to be used for this patient is x.xx " or something to that effect. (???)
 
The coders are usually the people who educate the doctors on how things NEED to be done. The doctors just know the basics of coding, they don't know all of the rules. For example, they may know the diagnosis for a certain disease, but they don't know that there may be a "code first" note or a "code also" note. It is up to the coding department to to tell them what is correct so maybe they won't do it wrong the next time. Coders are constantly reading up on the new rules for each year, doctors don't really do that. So, it's on your head (or your manager's) if the code isn't correct and you don't get paid or you don't pass an audit.

Just remember - documentation is the name of the game. If the doctor didn't document it in the chart, it didn't really happen. (even if he said it did LOL)

I don't know if you are the ONLY coder at your place, but the best thing to do is to take it up with your manager so he/she can go through the correct channels to get this resolved for you.
 
Both

AmandaW said:
What if the doctor wants you to code something a certain way that you know is really not right...a lot of times, it's a gray area, but not always...sometimes it's just not right. As a CPC, would I be ok if we were audited? Who's head is it on? Mine as the CPC or the doc? And if it's MINE, then would putting a note in our system stateing " Per Dr. X, the dx that is going to be used for this patient is x.xx " or something to that effect. (???)
Click to expand...

Actually you both would be liable in the event of an audit! You should educate your physician, show them documentation from a liable source as well. I had the same issue happen to me a few years ago and once I realized the docs "knew" what they were doing was fraudulent... that's when I started looking for a new position! You should also carry your own liability insurance as a coder, someone told me about it a few years ago and I now carry it. There use to be a link on this website to purchase the insurance, or if you could get your employer to purchase it for you, I know alot of coders that have this insurance have it because they are self employed but it would never hurt to carry it... you never know when you might need it....

But seriously... try to educate your physician as much as you can... get them on the right path....
 
What if you repeatedly educate the provider for correct coding and they still do not comply. Is documentation of your efforts and the provider refusal to comply enough to protect the you as the coder? If I remember correctly from conference last year, the legal panel stated that it is ultimately the provider who is on the line. But if the provider continues to code inappropriately does that establish the coder as someone who knows the wrong codes are reported and therefore is accessory to fraud?
 
Lisa Curtis said:
What if you repeatedly educate the provider for correct coding and they still do not comply. Is documentation of your efforts and the provider refusal to comply enough to protect the you as the coder? If I remember correctly from conference last year, the legal panel stated that it is ultimately the provider who is on the line. But if the provider continues to code inappropriately does that establish the coder as someone who knows the wrong codes are reported and therefore is accessory to fraud?
Click to expand...

Very good questions Lisa! I am not sure of the answer. I thought that if whomever is auditing knows that there is a certified coder on site, that they are just as liable as the physician? I can't remember where I heard that from it was more than 3 years ago but I want to say it was the consultant firm one of my old employers used?


I hope someone can shed some light on this for us, I'd be curious to know the answer to this one!
 
Lisa...that is EXACTLY what I should have asked...haha.

Examples would kinda of be like.....them wanting to code lung cancer 162.x when they have a neuroendocrine tumor...there's codes for neuroendocrine, but hardly any chemo drugs will cover the code I believe.

Also, something that was done before I became a coder at this clinic, and actually didn't even know that I was "supposed" to be doing it is with Ifex and Mesna...clinically they have to give Mesna with Ifex to prevent hemorragic cystitis (spelling?)...so they took it upon themselves to start using the 995.29 which is covered for Mesna...what I learned as a REACTION code, NOT a prevent code...so we're going back and forth with that lately. I don't see how that's justifiable at all but it seems the other coders I work with will go along with it to prevent an argument I guess-I don't know. I do plan on talking to my supervisor which is not a coder about it again.

But like we were saying earlier...what if it's situations that the doc or management want to do something that's not totally correct? It's not major things...whatever you would consider 'major' but still. Guess I need to start reporting them if I feel seriously about something, huh?

Thank y'all so much...maybe we can find an answer to this!! :)
 
Not TOTALLY correct?? How about completely wrong. The dx belongs to the patient and the code we select MUST match the dx documented for that encounter. We can choses nothing else. Regardless of the dx codes sited in the LCD/NCD we must use the dx code that fits the documetation. WE can do nothing else, to do otherwise means that you the coder are taking it upon yourself to diagnose the patient. Also each claim is potentially fraud. The patient can be harmed by our dx codes if we are incorrect. They can lose benefits, be denied benefits, have premiums raised, etc. You should never submit a claim with incorrect codes. If management choses to fire you for you doing your job correctly, then you should be prepared to accept that consequence. Harsh? maybe, but it is ethical.
 
Debra, I TOTALLY agree with you! It's hard working with other CPC's sometimes that just kinda go with the flow and not saying that they don't CARE, but just kinda look at it like management needs to make some of these decisions that I'm talking about. BUT WE need to...my clinic hired CPC's for a reason! Not just medical coders! I don't want to step on my fellow coder's toes or act like I'm better or know it all, BUT I AM going to stick up more for what I know is right. And it's also hard when your manager is NOT a coder!!!!!! But, ANYWAY...that's a whole other issue...lol. I did post a couple other questions on here that I've REALLY been wanting some insight on! Maybe you can help if you want to check them out. They are in the Auditing forum as well as the General-All things coding one.

Thank you for giving me a little nudge to have a back bone!! :)
 
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