Wiki Honest Conscience

[ajhunsicker]

Recently our office hired another employee, a graduate of a two year program from a local college which offers a Medical coding program. I myself graduated with a certification as a medical coding specialist from the same college and since have taken many courses and continuing ed, Webinars ect. also have been trying to pass the CPC exam. Pride myself in keeping up on all new policies, guidelines and rules. The new employee has 2014 coding books that coding has been done from. I have worked hard to get the physicians to the point of coding from the office notes. The new employee has been told to only code from the encounter/superbill. I feel this is so wrong, as I have already discovered missing charges, incorrect diagnoses, wrong POS, ect. The employee is also a member of AAPC and when I explained what was being done was wrong, billing must be done from the dictation/documentation. Per guidelines, the response was basically that what was told will be done needed job. Should the code of ethics not fall in to place here. Does no one have pride in their job/work anymore. I am so frustrated. Is there any fix to this... I feel so defeated. Thanks.

 

[Pam Warren]

First of all, congratulations on your position in a medical office. You've accomplished what many new coders find it hard to do.

I understand your frustration--you recognize the need to code for documentation and you're working towards certification and further understanding. But you don't have the ability to direct or instruct the new coder, because you're not the manager. Let's leave the new coder out of this, because she's simply doing what she's been told. In other words, don't make her life miserable because you think she's doing something wrong.

You could go to the manager and tell her that this new coder is doing something that you believe is unethical....but there may be a reason why the new employee has been instructed to code from the superbill, and then you're going to be in the unfortunate position of questioning the manager's integrity. If you put yourself in the middle of this, you may be seen as interfering with the manager's decisions. You'll look like a troublemaker and a tattletale. That's never a good place to be.

What you can do, is suggest to your manager that you and the new employee work together to learn coding and documentation guidelines. Offer to team up with her and do the work together, so that you can check each others' work for errors and inconsistencies. If the manager says "no", then drop it. She may explain why she's doing things the way she is, but the decision to run the practice her way is hers. If you can't live with that, then move on. But I'd strongly discourage you from forcing your newfound knowledge on everyone else, even if you believe it to be the best way to go.

Don't feel 'defeated' about a problem that's not yours. As long as you're doing your job the way you feel is best, and nobody's giving you a hard time, don't worry about what everyone else is doing. Chances are your manager knows about it, and may be making changes through claim edits on the back end that you know nothing about. Although many of those of us who are veteran coders are glad to hear that new coders understand the need for ethics, you have to place healthy limits and boundaries within the workplace. Don't create drama, because managers hate that.

Good luck.

 

[ajhunsicker]

Thanks Pam, so much appreciate your feedback. Unfortunately our manger was relieved of her duties over a year ago due to cutbacks. We have no current management position in this office. Issues are presented to the doctor(s). Again, I thank you for your response.

 

[Pam Warren]

Well, then, you've just been handed the golden opportunity. Have that discussion with the provider, and then ask him/her what he believes is the best way to proceed. Offer to spearhead a project to develop coding policies in your practice, and suggest that the new coder be included so that all coding/billing is done in a compliant manner. Don't blame or point fingers, just lay out the facts and then provide a solution. Work together to come up with a plan that everyone can feel comfortable with.

 

[cmoon]

My situation is a bit different but I think the same core issue. In our office, the only thing that matters is making goal. When my manager found out that I read every note before coding it she was surprised and wanted to know how much time that took! Long story short, we are expected to push the claims out without making sure they are correct. I have a real problem with this for a couple of reasons but my biggest concern right now is whether or not my credentials could be on the line. I know that a lot of claims are going out with insufficient documentation and many are not even billable based on the documentation. At best I think this is abuse if not outright fraud. I have addressed it with my supervisor and manager to no avail. Could my certification be at risk?

 

[Pam Warren]

Most organizations have productivity as well as accuracy standards, and healthcare is a business after all, so most offices/hospitals can't allow coders the luxury of reading through every note. The coders that work for me, that code for services that are not generated through and EHR are expected to read and code all operative notes, and then to quickly scan all of the level 2's and level 5's, new patient visits and consults to abstract medical necessity, diagnosis coding and to calculate MDM. Level 3-4's we do random audits, and we also do post-billing audits. I will say that we've spent years educating providers, and their documentation is typically spot-on. As you gain experience as a coder, you can pick out elements in just a few moments that support the level of visit you are coding. It shouldn't involve reading every word of the note.

Your certification is not at risk, unless you blatantly code something that is wrong, and you're aware of the error. You are being directed to be more productive, so pick and choose the work/providers you know might be a challenge, and do your best to meet the productivity standards that will keep your practice solvent. If the claims don't go out, and the money doesn't come in, then you can say goodbye to your job! That's the reality. Good luck.