An opinion piece on who should code and why
In the pages of this magazine, the following questions have been posed lately: "Who should code: physicians, staff, or someone else?", and "Why do we code, anyway?". As all physicians know, the responsibility for accurate coding sits squarely in their laps.
Taking a broader view for just a moment, there is an important national purpose for accurate coding. Physicians have been required by law to submit diagnosis codes for Medicare reimbursement since the passage of the Medicare Catastrophic Coverage Act of 1988. And for good reason: The International Classification of Diseases (ICD-9) classifies morbidity and mortality information for statistical purposes. It's one of the few good tracking systems we have for public health purposes.
The purpose of the Current Procedural Terminology (CPT) is to provide a uniform language that will accurately describe medical, surgical, and diagnostic services for reliable communication among physicians and third parties. CPT is useful for administrative purposes such as claims processing and for the development of guidelines for medical care review.
Play an active role
But the reality is that most physicians relate to coding on a more personal level. It's a burdensome responsibility, yes -- but accurate coding brings increased reimbursement, period. Not only do physicians' revenue streams depend on accurate coding, it is expensive to hand off tasks that are better done in "real time" by the provider on record.
Yet I often see physicians delegate not only the task of coding, but also all of the responsibility for coding to a staff member. The result? The physician -- who is ultimately responsible -- has no control over what is actually coded, and the outpatient coder likely has no idea what the physician actually did, let alone what was documented.
Most (but not all) 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.
It makes good sense
Adding a layer of staff to interpret what the physician does is an unnecessary expense. However, educating staff to support what the physician does makes good sense.
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. There are plenty of vendors that advertise, "You can learn to code in three days." Unlike professional coders, physicians need only to focus on the codes that concern their practice; this is a very small investment to assure its financial viability. If you're running a practice, strongly consider enrolling all of your physicians and staff in coding training.
Sherry Delio, MPA, HSA, is co-author of The Making of an Efficient Physician, and author of the sequel, The Perfect Practice for an Efficient Physician. In addition, Ms. Delio is director of clinic programs for St. Joseph's Hospital in Phoenix, Ariz. She can be reached at firstname.lastname@example.org.
This article originally appeared in the March/April 2002 issue of Physicians Practice.