Wiki Provider Coding Errors

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I have been told by one of my managers that CMO does not want me to notify the Provider of his coding Errors .

Dx codes are listed Incorrectly , Some services provided do not have the correct DX codes for labs and Xrays that are ordered .

I am wondering what type of impact this will have on my Credentials if the practice is audited.

Thanks for any input :
 
coding

Go to OIG website and show your manager the regulations that the office is supposed to go by.. After she reads I bet you will be allowed to do your job correct then:eek:

Developing a Coding Compliance Program
2009 Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.
of law. Process measures refer to the manner in which the program seeks to prevent and detect violations of the law. Outcomes measures refer to the observable, measurable results related to preventing and detecting violations of law and creating a compliant culture. Table 5-1 displays the structure, process, and outcome measures as they relate to a coding compliance program.
 
reree said:
I have been told by one of my managers that CMO does not want me to notify the Provider of his coding Errors .

Dx codes are listed Incorrectly , Some services provided do not have the correct DX codes for labs and Xrays that are ordered .

I am wondering what type of impact this will have on my Credentials if the practice is audited.

Thanks for any input :
Click to expand...

Go to OIG website and show your manager the regulations that the office is supposed to go by.. After she reads I bet you will be allowed to do your job correct then

Developing a Coding Compliance Program
2009 Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.
of law. Process measures refer to the manner in which the program seeks to prevent and detect violations of the law. Outcomes measures refer to the observable, measurable results related to preventing and detecting violations of law and creating a compliant culture. Table 5-1 displays the structure, process, and outcome measures as they relate to a coding compliance program.
 
You can correct these codes without notifying the doctor that you changed them, but you should NEVER submit a claim knowing that the codes are incorrect. Incorrect dx codes can make a payer pay for services that would otherwise be non covered, also they can have the effect of increasing the patient's risk and can cause their premiums to increase. If you knowingly submit a claim with incorrect dx or px codes you have much to be concerned about.
 
Doctor's usually have no clue about the order of diagnosis codes and some EMRs make this problem worse. I've seen one EMR that no matter what order the doctor puts the dx codes in once he saves his note they get listed alphabetically. No one noticed this until I questioned the dx. Another system I've worked with lists every dx on the problem list unless the doctor specifically deletes it from that note. How many docs are going to remember to do that? The nice thing about that system was it had a disclaimer stating the codes were provisional and could change based on review of documentation. So I wouldn't worry too much about correcting but not notifying the doc about dx codes before the claims go out. However like Debra said you never want to send out a claim with the incorrect codes.
 
Telling doctors of their coding errors

In my experience, most doctors appreciate being educated.
 
ruthie72 said:
If doctors are doing their own coding, I am sure they would appreciate the imput.:)
Click to expand...

The Doctor I code for leaves her charts open so that I can correct her diagnosis codes. Frequently her codes are not specific. I have had to hide codes on her charts so that she won't pull them again on another visit. She then reviews the encounter after it is coded properly and closes the chart. This takes a little more time, but the charts are much cleaner and they reflect the same codes that are billed.
 
RE:

kayhar@tds.net said:
The Doctor I code for leaves her charts open so that I can correct her diagnosis codes. Frequently her codes are not specific. I have had to hide codes on her charts so that she won't pull them again on another visit. She then reviews the encounter after it is coded properly and closes the chart. This takes a little more time, but the charts are much cleaner and they reflect the same codes that are billed.
Click to expand...

Hi!
As a coder, you can't "hide" anything from the doctor or anyone. You are a coder and to state that you hides things that could be detrimental to a patient's life... makes me wonder? Why?!
I'm not trying to come hard on you but to be more responsible in how you deal with serious issues. You need to communicate with the doctor and if the Doctor is coding charts incorrectly and you not saying anything. You showing lack of integrity and "hiding things" is highly unprofessional let alone you putting others at risk besides the patients also.

Are you aware that if you are Audited by MediCare and let's say they find anything wrong: Overpayments, Unbundling, Incorrect Coding, Intent to Defraud MediCare( the government), inproper diagnosis and/ or procedures. You can risk be fine, jailed, and even lose your status to work in a hospital who bills MediCare.

I would never hide anything for anyone. I don't care if the Doctor told me too. I would report the Doctor and also leave for a more honest company. I rather be jobless with my integrity than to be employed with dishonesty and deceitfulness.

It just pulled a nerve when I see comments of coders saying that have to hide things as if they are afraid of the doctor to be honest. Don't let no one nor Doctor get you in trouble for withholding any information nor a doctor should be telling you what to code for higher payouts, etc;

The doctor should be sent a "Query" in order to her to be specific with her diagnosis as your company could be missing out on monies if the codes as "unspecified". Not sure if you inpatient or outpatient. But you should have the doctor specify the diagnosis as they would cause your claims to get denied by the insurance company for inproper coding.
** Also per HIPAA Charts are NEVER TO BE LEFT "OPEN"- That is a serious violation of the HIPAA ACTS. Anyone can walk by and read a patients chart whom should not have access to it. Charts should only be access as part of your job such as working on a specific account. **
good luck!
 
I think you may have misinterpreted the posting. By "hiding" codes I think the coder puts them into a "grayed" out status; they are still available to the provider but no longer on the active list.

Also by leaving a record "open" I think this refers to not finalizing an electronic note so that it can be further editied, not literally leaving a paper chart open on the desk.
 
charissesimone said:
Hi!
As a coder, you can't "hide" anything from the doctor or anyone. You are a coder and to state that you hides things that could be detrimental to a patient's life... makes me wonder? Why?!
I'm not trying to come hard on you but to be more responsible in how you deal with serious issues. You need to communicate with the doctor and if the Doctor is coding charts incorrectly and you not saying anything. You showing lack of integrity and "hiding things" is highly unprofessional let alone you putting others at risk besides the patients also.

Are you aware that if you are Audited by MediCare and let's say they find anything wrong: Overpayments, Unbundling, Incorrect Coding, Intent to Defraud MediCare( the government), inproper diagnosis and/ or procedures. You can risk be fine, jailed, and even lose your status to work in a hospital who bills MediCare.

I would never hide anything for anyone. I don't care if the Doctor told me too. I would report the Doctor and also leave for a more honest company. I rather be jobless with my integrity than to be employed with dishonesty and deceitfulness.

It just pulled a nerve when I see comments of coders saying that have to hide things as if they are afraid of the doctor to be honest. Don't let no one nor Doctor get you in trouble for withholding any information nor a doctor should be telling you what to code for higher payouts, etc;

The doctor should be sent a "Query" in order to her to be specific with her diagnosis as your company could be missing out on monies if the codes as "unspecified". Not sure if you inpatient or outpatient. But you should have the doctor specify the diagnosis as they would cause your claims to get denied by the insurance company for inproper coding.
** Also per HIPAA Charts are NEVER TO BE LEFT "OPEN"- That is a serious violation of the HIPAA ACTS. Anyone can walk by and read a patients chart whom should not have access to it. Charts should only be access as part of your job such as working on a specific account. **
good luck!
Click to expand...


I think you probably meant well, but I think you may have taken kayhar's comments out of context, and in doing so have chastised her for something you may not have understood. As coders, I'm sure we're all aware of the ramifications of submitting improper claims, the parameters regarding HIPAA guidelines and the importance of coder ethics. And it's evident that you're quite passionate about your work. Although we appreciate your enthusiasm, I don't think kayhar's done anything to warrant a call to the OIG. Remember, not everyone is flipping through paper charts any longer. It appears to me that she's being very professional by verifying 4th and 5th digit specificity in her EHR's ICD-9 library, and keeping the chart open (or unbilled) until she can speak with her provider to verify if it's correct. And if her EHR is like ours, she can and should "hide" invalid or incomplete ICD-9 codes so that they're not inadvertently used in error, which would be inappropriate, as you know. Your post felt a little bit (to me) like you were reading her the riot act, and I just wanted to point out that I do not believe it was warranted. Let's please be helpful and professional on this public board so that everyone can take advantage of each others' expertise.
 
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