Wiki Proper and Consistant Coding

[lillianivy]

I need help. I am the primary coder in our office and have been the only one for the longest time. We have recently increased our services, therefore, have hired a part-time coder to help when needed. We have set policies and procedures. The new coder refuses to comply. She has been coding for years and set in her ways. And due to certain personal circumstances she cannot be let go. I have informed her the importance it is to be consistent and the fact that we follow NCCI coding edit/CPT/ICD-9/HCPCS guidelines. I have spoken with my supervisor and have been told since I am the Main Coder it is my responsibility to inform her and have her comply. Yet, no authority to discipline.

One of the issues is the order of the CPT codes. We can have up to 20 or more CPT codes on one claim. If you plug in all codes in a NCCI edit tool it list the codes in a certain order. Therefore, we have been listing them in the proper order when billing. And have been for years. She refuses to comply with this and argues that it doesn't matter. Is there any document out there that can state the importance of proper order of CPT code billing. I've been taught in school that this is the proper protocol, plus when studying for the exam before I took it, it was clear that the codes needed to be in a certain order. Same goes with DX. Which all facilities have there own policies they comply to. Previous coding jobs I have had the same policy that had to be applied.

There are other policies that she also does not comply with, that relate to our facility's personal policies. We put certain data in line 19 and have been for years. Certain insurance's will pay for some services and some do not, therefore I bill for those services. She refuses to bill for those services at all. Claiming it's not necessary. My thinking is every insurance policy is different and if they pay for that service then you bill for it. Plus we are loosing money when she refuses to bill for it.

I guess my main concern is with this inconsistent coding, could this possibly lead to attention from all insurance companies. I definitely don't want to draw attention to us to cause an audit. Is there any articles or information that can help support my case. Or tell me that CPT codes being billed in a certain order does not matter. It would be nice to have in writing Guidelines/Articles that support my argument and to support our facilities personal policies being followed.

Thank you!!!

 

[johnmeyer]

Oh, this is a hard one. To get someone to comply, yet have no ability to discipline... I'm not sure what you could do aside of keep bringing up her inability to conform to protocols and correct coding per NCCI edits to your supervisor.

I'd have go back over my old school notes to find references, but you are right in thinking that there is a proper order of entry for call codes (CPT, ICD-9, and HCPCS), which is extremely important in hospital coding more so than office coding. And the NCCI edits should be the end of the discussion.

If you've had denials because of her incorrect coding, you might want to show her thoose to prove to her that it really does matter.

At any rate... I wish the best of luck because I know what it's like having to deal with someone who is so inflexable that she/he can't conform to industry standards.