Client doesn't bother with procedure codes.

[williamportor]

Hello - I have just signed up another Chiropractor client, pretty typical in all respects, except the fact that he doesn't bother with procedure codes. He fax's me his daily ledger sheets for claims submission with abbreviations of what he's done. i.e. Chiro. 3, EMS, Ther, Ex etc. He also faxed me a detailed description of these, and the prices for each. I know many of these codes, since I've done Chiro. billing for 4 years now, but sometimes I have to choose between 2 or 3 codes and I am not a certified coder. I made up a list of the codes I've used for his claims and the descriptions for each and faxed it to him, but he has said nothing about it. I guess this is OK, but I'm a little uneasy about doing the coding myself. Have any of you encountered this? Any suggestions would be welcome.     

[Michele]

I just want to make sure I understand.  We have a similar situation. One of our DCs has internal codes for his procedures.  For example, he uses something like:

K = 98940
C = 97010
T = 97032

etc.  Then on his billing he puts "K,C"  or "K,C,T"  or just "K" and then we code appropriately.  So if you are describing something similar you are not coding, you are simply translating his abbreviations into the appropriate CPT codes. 

If he is giving you abbreviations then he's telling you what he did, just not using CPT codes. 

[williamportor]

Yes, abbreviations is exactly what he is doing. He did respond to my list of codes and explanations, saying "looks good to me" but he didn't seem very interested. Maybe I worry over details too much, but I don't want to get blamed if these don't pay because of coding issues.

[Michele]

It's good to make sure you are doing things correctly.  But if you are just taking abbreviations and changing them to codes that he specified for the abbreviations you should be fine. 

[PMRNC]

I have a completely different opinion. First we know for a fact that coding is done based on what the doctor did but also on what was documented. The problem with using internal codes or abbreviations is that they are non compliant if an audit arises. I would also want to know what your contract states in regards to your job duties. When you are "intepreting" codes based on an internal coding system the doctor has in place (and in your case I don't have much faith he even understands at all) you are doing so with a non compliant process. If your contract states that it's the responsibility of the client to code then he should be coding and doing so based on his documentation. If you were a coder and one of your responsibilities in your contract were to code, you would be ok relying on the documentation in the file which would be fine, but using any other internal coding process means you are working on blind faith. In other words even if a provider gave you a list of, let's say A-Z and what procedures they are but no CPT. An audit occurs, that audit is not going to go well without the proper coding procedures in place.

Any easy fix for this is to get him or make him a superbill where he checks off and signs off on the superbill.

If he still isn't interested, then he's not interested in being compliant, nor is he too concerned with your liability. Remember that you are billing proceures based on HIS internal coding system he basically made up, that makes you very vulnerable.  Review your contract, make sure your job duties and responsibilities are crystal clear and go over with the provider and explain the problem while offering up solutions to help him out. If he is unwilling, you have to ask yourself if he's worth the risk.

I never pretend to like chiropractors at all ... I had one years ago when I started and swore I'd never take on another. Story for another time and JMHO.

[Michele]

Linda's advise is good.  The situation we have may be different than yours Williamportor.  In our case the charts and documentation are all compliant, it is simply a sheet that the DC uses to relay the info to us.  So the info in the patient's chart shows the correct CPT and notes, but he does a summary sheet of all patient's seen with the internal codes.  His codes are crystal clear and he has a list of his abbreviations.  We've been working for him several years and it's worked great. 

However, what Linda is saying is correct and I should have been more clear in my post.  We are not certified coders and we don't code for our providers.  This (at least to me) is not coding.  But it sounds like my DC is much clearer than yours with his data.

We work with and have worked with DCs for over 25 years.  Some are a nightmare, and some are fine.  The issue is that reimbursement for DCs is so low and insurances make them jump thru hoops (authorization, etc).  We have a couple that are very good with their paperwork, they dot all of their "I's" and cross all their "T's" and are great to work with.  We have had some in the past that were not as good about that.