Medical Billing Forum

Coding => Coding => Topic started by: Scott on February 09, 2016, 06:55:06 PM

Title: Should billers do coding?
Post by: Scott on February 09, 2016, 06:55:06 PM
Hi.  I know this might be a basic billing question, but I want to get an opinion on whether or not we as medical billers should do coding for a provider.  Maybe the question should be when is it appropriate to make suggestions to a provider about using a specific code.

Here's a real example we recently encountered.  We just took over an account from a previous billing company.  We received a superbill from one of the dr's in our client's office on which he simply wrote the diagnosis "L Otitis Externa".  Neither the dr nor his staff knew the specific ICD10 - only that it started with H60 - and that it was perfectly fine with them for us to look up the appropriate code and bill it.  Would we be crossing a line by looking that diagnosis up and using the most accurate ICD10?  Or, do most billers require the dr to give the right code and if he can't, to tell him we won't be able to bill it?
Title: Re: Should billers do coding?
Post by: PMRNC on February 10, 2016, 07:05:30 AM
Quote
Hi.  I know this might be a basic billing question, but I want to get an opinion on whether or not we as medical billers should do coding for a provider.  Maybe the question should be when is it appropriate to make suggestions to a provider about using a specific code.

Here's a real example we recently encountered.  We just took over an account from a previous billing company.  We received a superbill from one of the dr's in our client's office on which he simply wrote the diagnosis "L Otitis Externa".  Neither the dr nor his staff knew the specific ICD10 - only that it started with H60 - and that it was perfectly fine with them for us to look up the appropriate code and bill it.  Would we be crossing a line by looking that diagnosis up and using the most accurate ICD10?  Or, do most billers require the dr to give the right code and if he can't, to tell him we won't be able to bill it?

This is actually a great question. Of course it will depend on the experience of the biller, contract terms, etc. I do NOT code, however I will double check codes if something doesn't look right, my clients go through the superbills and check off the codes already in place, sometimes they may add something else and If it's straightforward I'll go ahead and put a code BUT it goes back to the physician to ok/initial.  So for example, my ped's clients have their superbills in charts with patient, they would check off otitis media which would then have the proper code next to the right one, as you probably know now there are quite a few specific dx's for Otits Media. 

So there really isn't a right or wrong answer but I'll add my number one saying where this is concerned..  CYA!!!   If you bill it, you are just as responsible so if in doubt send back to the provider for them to sign off on. Make sure your contract is specific with the responsibilities of coding and who will do what, and to what extent!
Title: Re: Should billers do coding?
Post by: Scott on February 10, 2016, 10:42:22 AM
Thank you so much Linda.  I appreciate it.  Having the Doc initial our code suggestion was actually one of the options we discussed internally. I also looked through our contract and concluded I need to tighten the language up too. 
Title: Re: Should billers do coding?
Post by: RichardP on February 10, 2016, 01:22:44 PM
Would we be crossing a line by looking that diagnosis up and using the most accurate ICD10?

To add to what Linda said - here is a more general guideline re. your question quoted here:

Without access to the patient's chart, how do you know which is the most accurate ICD-10 code?

Without having access to the patient's chart, one cannot possibly know which is the most accurate ICD-10 code.  Without having access to the patient's chart, how can one possibly code?

Of course, if you do have access to the patient's chart, then it is up to you to decide whether you want to offer coding as a service.  If this is your situation, then I refer you back to Linda's response.