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AmandaM2153

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I am being asked by my employer (physican clinic) to ask the provider first before changing what they have in the EMR (because it's either wrong, or over/under coding). Their defense states that because if audited the code at the bottom of the EMR would not match with claim - but I always thought auditors will look at the NOTES not the little code at the bottom...
Also they are telling me to just push through the claims and not even look at any of them so we can get caught up. How does that work with my certification and audits? If I submitted something that wasn't right will I get in trouble? And their defense is no it would be the provider liability, although it's not the provider submitting it...

HELP is GREATLY appreciated!!!!!
 
AmandaM2153 said:
I am being asked by my employer (physican clinic) to ask the provider first before changing what they have in the EMR (because it's either wrong, or over/under coding). Their defense states that because if audited the code at the bottom of the EMR would not match with claim - but I always thought auditors will look at the NOTES not the little code at the bottom...
Also they are telling me to just push through the claims and not even look at any of them so we can get caught up. How does that work with my certification and audits? If I submitted something that wasn't right will I get in trouble? And their defense is no it would be the provider liability, although it's not the provider submitting it...

HELP is GREATLY appreciated!!!!!
Click to expand...
As an auditor I look at the physicians notes but you should talk with the provider before changing any code. (I am not sure what you mean by the little code at the bottom of the EMR)
I have always been taught that they biller/coder is also responsible if submitting fraudulent claims.
 
"The little code at the bottom" is a code that the provider picks as procedure - so if they say 99213 it will show up at the very bottom (and it's really there just to get the Encounter Form for billing generated) If that code at the bottom is different than what we bill is that something to cause you to look further? Or are you just interested in what the provider actually documented for the visit itself?
 
You as a coder, should never change codes that the physician has coded, without discussion with the physician. Coders can be held accountable.... EMR E/M notes should only be change by the doctor.
Brenda Lewing, LPN, CPC, CPMA
 
I'm not changing the code on the note - I am coding by the documentation and submitting that to the insurance. But that is where the discrependcy is - does the code at the bottom of the page matter to the auditor? Its just what the provider picked - but the documentation should be the real factor that the auditor is looking at are my thoughts...
 
brendalewing said:
You as a coder, should never change codes that the physician has coded, without discussion with the physician. Coders can be held accountable.... EMR E/M notes should only be change by the doctor.
Brenda Lewing, LPN, CPC, CPMA
Click to expand...

Brenda, coders are always responsible for the code they assign. Never should a code be assigned without the document in front of the coder. Regardless of the code selected by the provider, the coder must assign a code supported by the documentation. It does not matter if the number on the claim matches the number the provider puts in the chart note. The coder is not required to discuss any coding changes with the provider. We need to recognize that providers are not taught coding and coders are not taught diagnosing. The coder only gets to use the medical record and the coding guidelines for code assignment.
 
Encoder?

Is that "little code at the bottom" one that the PHYSICIAN codes or one that is generated by an encoder and the physician simply clicks it? There is a difference between those. Our EHR has an encoder that does that - suggests an E/M code for the physician and the physician can choose that one or ignore it and choose another.
 
The code is chosen by the physician - there was not an encoder attached….

But now I have been fired from this job… They said it's because I was not cooperating… Anyone have any documentation in writing from a legit source about what is facts and not?! I need help…

Thank you
 
mitchellde said:
Brenda, coders are always responsible for the code they assign. Never should a code be assigned without the document in front of the coder. Regardless of the code selected by the provider, the coder must assign a code supported by the documentation. It does not matter if the number on the claim matches the number the provider puts in the chart note. The coder is not required to discuss any coding changes with the provider. We need to recognize that providers are not taught coding and coders are not taught diagnosing. The coder only gets to use the medical record and the coding guidelines for code assignment.
Click to expand...

And I completely 100% agree with you -- until this new person came I NEVER once had an inkling that a certified coder had to “talk it over” with the provider to get it changed! I am not denying that a provider should be spoken to about their “overall coding” and give short lessons so they are more accurate and know what to expect for their RVU payments; but like I kept saying -- If they overcode, the clinic pays out RVUs, then the clinic gets audited and money taken back… that provider still gets those RVUs…
And your last sentence is something I kept trying to explain… They were comparing to other clinics (and i called a few that I knew also) and yes IF the provider is trained extensively in coding I WILL trust what the provider is choosing and only do monthly audits -- BUT if they are not, then I believe every chart needs to be gone through.

They did not like my answer and decided to let me go. How amazing is that….
 
first it depends on your state employment laws... as in are you an "at will" employement state? if so there is not much recourse as you are employed at the will of the employer and can be discharged without cause.
Also it was a 2012 coding clinic from the AHA either first or second quarter that addressed that the numeric code should not be in the medical record.
also when you look for a new position just explain that you were discharged for wanting to perform the job correctly.
 
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