Wiki Please help! - I have been working in the medical field for almost 10 years

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ajhunsicker

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I have been working in the medical field for almost 10 years, took the associates course at the local college for medical coding and graduated and missed my first time CPC exam with AAPC by 7 points, will be taking again hopefully in January again. My question is. The practice I work for has two physicians. The one is not being very complaint when it comes to the documentation and the choice of E/M codes. I have tried several times to explain how it must be done if she is charging a NP 99204 all 30 and a high complexity MDM DOCUMENTATION. She has said that no other office codes from the documentation that they all code from the encounter/super bill. Plus, I have gone over and over with them as much as given them an outline for each E/M like a report so that they can do their dictation and she is still coming to me and asking me what she need to dictate to charge the higher level. I feel that I am pushed against a wall here, and my stomach is in my throat can anyone give me some good advise....???? So, so upset right now....
 
ajhunsicker said:
I have been working in the medical field for almost 10 years, took the associates course at the local college for medical coding and graduated and missed my first time CPC exam with AAPC by 7 points, will be taking again hopefully in January again. My question is. The practice I work for has two physicians. The one is not being very complaint when it comes to the documentation and the choice of E/M codes. I have tried several times to explain how it must be done if she is charging a NP 99204 all 30 and a high complexity MDM DOCUMENTATION. She has said that no other office codes from the documentation that they all code from the encounter/super bill. Plus, I have gone over and over with them as much as given them an outline for each E/M like a report so that they can do their dictation and she is still coming to me and asking me what she need to dictate to charge the higher level. I feel that I am pushed against a wall here, and my stomach is in my throat can anyone give me some good advise....???? So, so upset right now....
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What do you mean by "all 30"?
 
I'm sorry just so frustrated right now, referring to 99204 and that it requires all 30 systems examined for the Exam...
 
Sort this out

I'd like to try to sort out the issues you are facing with the doc. Sounds like she codes 99204 most or all of the time for new visits. But her documentation doesn't support the 99204. And she either argues that most coders code from the superbill in "other" practices or you should help her document up to a 99204. You have provided feedback and documentation information to her but it hasn't helped.
You can tell her the coding from a superbill is not coding but copying. You may have already told her that! I know it is a small practice but is there a practice manager you can discuss this with? You also could do a Google search for OIG settlements and audits for upcoding. There have been many. Upcoding without documentation to support it is cited by the OIG as either fraud or abuse depending. You can get a listing of the civil monetary penalties and criminal penalties. Fear of lost $ and prestige sometimes works.
Having said all that 99204 isn't necessarily an unreasonable level for a patient new to a practice since providers often will do a complete work up. In your view, is this a documentation issue? That is more reasonable to resolve than the doc simply upcodes and doesn't care.
If there is someone you can appeal to, you might recommend an outside coding audit. Often providers who won't listen to an employee will listen to a consultant.
And good luck with the second try. I'm sure you will pass this time. And having some letters after your name should help with the providers.

Jim S.
 
Thank for the reply you answer has helped some of my questions. I just have one final question. She is arguing that we do not need to bill from the documentation. Just from the super bill/encounter. Can I find something in black and white that states other wise. Thank for the help. I greatly appreciate it.
 
ajhunsicker said:
Thank for the reply you answer has helped some of my questions. I just have one final question. She is arguing that we do not need to bill from the documentation. Just from the super bill/encounter. Can I find something in black and white that states other wise. Thank for the help. I greatly appreciate it.
Click to expand...


That depends on your role in the office. If you were hired, and are responsible for, coding, then no, "coding" from the superbill is not acceptable. You can only guarantee that the correct code is chosen by reviewing the documentation in the chart, not just the superbill. "Coding from the superbill", as I've heard it called, is actually more like data entry/billing. As a certified coder, even if you are performing one of these duties, you are obligated to intervene if you notice something not right with the codes you are seeing.

As far the "30" exam systems...that depends on which year of the DG you are using. It is quite possible to meet the requirements of a comprehensive exam using the 95 DG instead of strictly the 97. I know that most specialists tend to go for the 97, but I can say, as working for nothing but specialists, my providers genereally do better with the 95 instead. That will just depend on their documentation patterns.


Hope this helps some! :)
 
http://oig.hhs.gov/compliance/physician-education/02payers.asp


Physician Documentation
Physicians should maintain accurate and complete medical records and documentation of the services they provide. Physicians also should ensure that the claims they submit for payment are supported by the documentation. The Medicare and Medicaid programs may review beneficiaries' medical records. Good documentation practice helps ensure that your patients receive appropriate care from you and other providers who may rely on your records for patients' past medical histories. It also helps you address challenges raised against the integrity of your bills. You may have heard the saying regarding malpractice litigation: "If you didn't document it, it's the same as if you didn't do it." The same can be said for Medicare and Medicaid billing.

There is a lot of information out there about the false claims act and providers under corporate integrity agreements (CIA). As someone who acts as an IRO and audits many different providers under CIAs, I can tell you I compare the paid claim to the medical record, not the billing sheet.

Hope this helps,

Laura, CPC, CPMA, CPC-I, CEMC
 
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