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April,
I responded to your PM, but it looks like things have escalated for you. I am truely sorry you are in this position. If you are the one creating the claim, honestly you need to just put the correct codes on the claim. The codes on the claim only need to match the medical record documentation, if they do not match the number selected by the provider that is OK. What you cannot do is leave incorrect codes on a claim and know it is submitted in that way.
good luck to you, and I applaud you for doing the right thing,
 
I'm sorry you're having to experience this lack of professionalism in your office. I have a couple of thoughts, though.

I'd arrange a private, after-work appointment with your physician, and ask him to explain to you what he feels your role is within the practice. If this does not match what you think you're expected to do, then relate to him what you feel your responsibilities are as a certified coder. Take the time to explain the concept of correct coding (from financial, patient care and compliance perspective), and ask him if this is what he expects you to do.

Here's what I suspect the problem might be....Find out what it is about your guidance that is ticking him off. Are you constantly downcoding him? If it's a private practice, he might be worried about money, so let him know that you can assist him with documentation tips to improve his bottom line. Coders are supposed to assist physicians, not be the self-appointed gestapo, so at least take a moment to consider your delivery, and your timing. If you're catching him mid-patient, he's not gonna love it, so perhaps scheduling coding training time is better than tackling him in the middle of the day. It sounds like every time you find a problem, you run right to him, regardless of what he's in the middle of. My doctors would behead me if I tried that, so I'm willing to bet that's what's making him nuts. Pick your battles and then schedule a time when he's not seeing patients....or get his approval to make coding changes without his having to consult on every little thing. Doctors can be funny people, but are typically able to see reason if you dangle it in front of them.

I'd also let him know that screaming at you in front of patients is certainly going to cause patient satisfaction issues--no patient wants to view that kind of drama; and screaming in front of other staff members is likely to cause morale problems. Let him know that this is no longer acceptable. Then you might point out that ICD-10 will certainly require his cooperation and your expertise, and this is not a good time to alienate his coder (you can say this nicely, but you get my drift...).
If after this kind of discussion, and after moving your meeting times with him to another time during the day or making coding changes on your own, things don't improve, then move on. This is not worth the aggravation.
 
First of all, I agree with Pam's post. During a busy work day is not the time to bring coding problems to the doctor. One thing that I found that works for me, I developed a "feedback" form. On this I state what the documentation says then I explain why and in what areas it may be deficient (i.e. based on CPT rules, NCCI edits or the insurance company coverage determination, etc.) I let them know what the documentation does support and requst a response. The docs also know that any charges being questioned will be held until they respond. Sometimes they just write ok on my form and sometimes they request a meeting to discuss it. Either way I get a response, they are not bothered in the middle of the day and if they question why a charge has not gone out I can refer them back to the feedback form if they have nto responded to it. This makes us all a little happier, they are not bothered during the day, I get my responses and they get some training.

I do know what you're going through, I worked for a doctor that screamed in front of the patients. It may help by not confronting him when he's seeing patients, but if he doesn't stop after you speak with him, you may need to consider moving on. Hope things work out for you.
 
I would follow all the great suggestions here. Set a time for a meeting with the physician. If there is also someone in the office in a practice managment/HR role possibly consider including them.
 
I'm really sorry that you are going through this. While he is acknowledging he is doing something wrong he's continuing to make the mistakes and be angry. It sounds as though you attempted to turn this into an educational opportunity and it wasn't well met. I'm not sure you can do anything else than what you are doing and have done.

If the EHR is what he says the issue is, can you work with the vendor to provide additional education to him, or a better/easier template for him to use? Have you tried saying "Dr. X, I'm sorry that you feel this is personal but I provide the same feedback to all the physicians in our practice. While you are acknowledging the error, what can we do to work together to get this corrected?" If he starts to yell at you in front of people and berate you I'd respectfully request to discuss it at a meeting when he's calmed down.
 
Do you report to the Office Manager? Not knowing the heirarchy of your Practice, I would suggest a meeting with your supervisor to report and discuss his behavior. I agree with all the the above suggestions, especially confirming what they view your role should be. However, coding issues aside, this Dr's behavior is unacceptable and should be challenged. Regardless of the reason or choice of time and place for your encounter with any provider, you should not tolerate abuse in any form.

Although easier said than done, you may also want to consider looking for another job.
 
The other physicians and the Office Manager should not allow any employee, even a physician, to abuse another. They should support and defend each employee. He should be counseled regarding this with consequences should he continue. Good luck to you. I've been in this situation before and no job is worth it.
 
Sounds like he is taking his insecurity about the EHR out on you. His partners and the office manager should intervene - it sounds like you've done all you can.

If I'd been the patient in this case, I'd have chewed him out - no one needs that sort of stress, and it is not professional. He is planting doubts as to his competience, and the competence of his staff in the patient's minds! I'm sorry he's having a rough time, but that is no excuse for stressing you out, or being so unprofessional.

I hope things work out soon - it would be a major pain to job hunt, and a loss to this practice if you choose to leave. He'll be a lot more stressed out if he has to break in a new coder!
 
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