Coding …

All physicians know this answer or at the very least know where the responsibility for accurate coding falls … directly into the lap of the provider! Physicians have been required by law to submit diagnosis codes for Medicare reimbursement since the passage of the Medical Catastrophic Coverage Act of 1988. The International Classification of Diseases (ICD-9) classifies morbidity and mortality information for statistical purposes.

The reality for physicians is coding is a burdensome responsibility. However, accurate coding brings increased reimbursement, period. Not only do physician’s revenue streams depend on accurate coding, it is expensive to hand off tasks that are better done in “real time” by the provider of record. Physicians not only frequently delegate the task of coding but also all of the responsibility for coding to a staff member, resulting in ‘the physician,’ who has all the liability, having no control over what is actually coded and the coder likely having no idea what the physician actually did, let alone what was documented. Especially for hospital services.

Many physicians will write down a diagnosis and leave it up to the staff to interpret and assign a code. Often, the staff member never sees the physician’s documentation. This breakdown leads to two very serious errors.

First, the staff member can misinterpret the physician’s note and then bill for the wrong diagnosis — a common error. Second, without relying on the documentation, the staff may code for a service that the physician did not actually perform. The credo of medical legal experts is that if it was not documented, it was not done. In either case, you face delayed or decreased reimbursement, or the accusation of fraud.

Take Ownership of Coding

• Don’t delegate coding;
• Accurate coding brings increased reimbursement;
• Don’t add on the expense of a coder … it’s just not necessary!
• Education of staff to support what you do makes good sense.

If You're Going to Do It, Do It Right the First Time

The only way to be paid in a timely manner is to send out bills that are error-free. The two most common denials originate from either poor demographic or insurance information or coding problems. Many physicians believe that hiring a certified coder and a good collector will maximize their reimbursement and circumvent potential problems. But without proper input of demographic and insurance information, coding and collecting are pointless. The real solution is for physicians to take responsibility for the coding, and to educate staff to collect and input data appropriately. If physicians are responsible for the coding, then educating staff to collect and input appropriate demographic and insurance information will result in far better reimbursement. Large groups should consider investing in a coding expert to train staff and physicians. If you run a practice consider this training a must.

Coding Issues? Call the PSI coding hotline at (800) 738-6616.