CodeDecider_8-18-15Last week I spent a lot of time trying to explain the ICD-10 code for “late effects of radiation” and why it was “right” even thought it seems wrong because it is in “injury and poisoning” code. That gets me to the straight talk topic of “who decides what the right code is?” A doctor in private practice is not likely to allow anyone someone from the business office to just change codes that he or she might have selected. If you have a good business manager or billing office, they should alert you to changes, but it’s hard to imagine a doctor who would be comfortable with a coder simply “changing things” without letting the doctor know. That’s what happens in the hospital based outpatient clinic, even though all the care the hospital staff provide are delivered “incident to” the doctor’s visit. I have a LOT of heartburn at the idea that a hospital coder could change a diagnosis code I specifically selected and charted for a patient, because if the hospital claim is denied as a result of their alteration, MY bill could be denied (and vice versa, by the way). Or worse, I could suffer a recoupment on post payment review because of something the coder did. So, I am responsible for the right code, and I am NOT HAPPY about anyone changing anything unless you ask me first. In fact, I am pretty sure they are not supposed to do this in site of service 22, even though it happens.
So, I am just curious how you feel about it?