Read on the following medical billing question and the expert answer.
Question: You work in a general and laparoscopic surgeon's office. Once he helps other surgeons you get the medical billing information from the other surgeon's coders to bill as the assist.
Occasionally there is inappropriate medical billing relating to the CPT codes as well as ICD-9 codes billed, as per the documentation from the operative report. There is contact made to have them prove and correct, but it is not always followed through with by the lead surgeon's office.
In effort to get the claim submitted in a timely matter you have submitted the claimyou're your doctor as the assist. You have done it in two methods: 1) submitted as billed by the lead surgeon, making notes on the explanation for the errors/problems and 2) submitting the claim with the precise medical billing information.
What is the correct way to handle this problem?
Answer: You must never deliberately send in the wrong codes just to get paid. That is a clear coding and compliance violation.
Your practice of calling the other surgeon's coder and trying to clarify why you will be submitting not the same coding is a good start. In case they don't agree or follow through with the proper coding, though, you must still submit the codes you consider are accurate.
Tip: Send an email to the lead surgeon's practice clarifying the codes you will be submitting and the reason why you are submitting these codes. This makes certain you have your contact with the other coder in writing, and demonstrates you informed them that you planned to submit distinct codes.
You won't probably know what the other surgeon ends up submitting or if they get paid -- but it's not really your area of concern. Given that you are compliant and getting in the reimbursement your surgeon deserves, you're performing your job properly.
Warning: Getting paid might be a bit more challenging when the other surgeon is submitting different codes. You might require appealing a denial that comes from the surgeons submitting dissimilar codes, however in the appeal process if your coding is precise you should get paid.
Bottom line: You should all the times code appropriately and avoid knowledgeably submitting an improper claim just to match the other surgeon's medical billing. In case you think about it, when there is an assistant surgeon, there are three sets of codes the payer gets: the primary surgeon, the assistant surgeon, and the facility as well as not all three are always in sync. Facilities and surgeons don't talk over the coding and work collectively to ensure they have the same result. Each individually codes the case. Why shouldn't the assistant surgeon carry out the same, particularly if they already have a highly qualified coder.
Get more medical coding and billing tips like these. Click here to read get access to our monthly Medical Office Billing & Collections Alert newsletter: Your practical adviser for ethically optimizing billing and collections for your medical practice.
Question: You work in a general and laparoscopic surgeon's office. Once he helps other surgeons you get the medical billing information from the other surgeon's coders to bill as the assist.
Occasionally there is inappropriate medical billing relating to the CPT codes as well as ICD-9 codes billed, as per the documentation from the operative report. There is contact made to have them prove and correct, but it is not always followed through with by the lead surgeon's office.
In effort to get the claim submitted in a timely matter you have submitted the claimyou're your doctor as the assist. You have done it in two methods: 1) submitted as billed by the lead surgeon, making notes on the explanation for the errors/problems and 2) submitting the claim with the precise medical billing information.
What is the correct way to handle this problem?
Answer: You must never deliberately send in the wrong codes just to get paid. That is a clear coding and compliance violation.
Your practice of calling the other surgeon's coder and trying to clarify why you will be submitting not the same coding is a good start. In case they don't agree or follow through with the proper coding, though, you must still submit the codes you consider are accurate.
Tip: Send an email to the lead surgeon's practice clarifying the codes you will be submitting and the reason why you are submitting these codes. This makes certain you have your contact with the other coder in writing, and demonstrates you informed them that you planned to submit distinct codes.
You won't probably know what the other surgeon ends up submitting or if they get paid -- but it's not really your area of concern. Given that you are compliant and getting in the reimbursement your surgeon deserves, you're performing your job properly.
Warning: Getting paid might be a bit more challenging when the other surgeon is submitting different codes. You might require appealing a denial that comes from the surgeons submitting dissimilar codes, however in the appeal process if your coding is precise you should get paid.
Bottom line: You should all the times code appropriately and avoid knowledgeably submitting an improper claim just to match the other surgeon's medical billing. In case you think about it, when there is an assistant surgeon, there are three sets of codes the payer gets: the primary surgeon, the assistant surgeon, and the facility as well as not all three are always in sync. Facilities and surgeons don't talk over the coding and work collectively to ensure they have the same result. Each individually codes the case. Why shouldn't the assistant surgeon carry out the same, particularly if they already have a highly qualified coder.
Get more medical coding and billing tips like these. Click here to read get access to our monthly Medical Office Billing & Collections Alert newsletter: Your practical adviser for ethically optimizing billing and collections for your medical practice.
