Suspicious Coding

March 1, 2004

I'm worried that one of my partners is overcoding. He just doesn't seem to spend as much time as he'd need to code like he codes. How can I make sure everything is OK without openly confronting him?

Question: I'm worried that one of my partners is overcoding. He just doesn't seem to spend as much time as he'd need to code like he codes. How can I make sure everything is OK without openly confronting him?

Answer: Here are several suggestions that I have seen work for under- and overcoding:

  • Hire an external consultant and let her be the heavy. Although it costs some money, it takes the issues out of the group. Politically, that is often wise for very sensitive issues. Be sure the consultant looks at everyone's coding, not just the one you're worried about.
  • Hire a coder on staff to audit charts - again, all of them, or at least a random sample including every physician's, not just those of the physician in question.
  • Audit your own coding in an anonymous peer review. At the end of each quarter, have each physician in the practice pull 10 charts. Review one another's coding retrospectively, as an auditor would do. If you vary in specialty, you can just focus on the E&Ms.
  • If you're certain the physician is over-coding, have an attorney sit down with him and discuss how he is putting himself and the group at risk.
  • Bring in the risk management department of your malpractice carrier. The carrier works for you, so it won't hurt to describe the situation and have a risk manager offer intervention.

However you decide to handle it, make sure you do handle it. The physician is putting your group at risk. This should be addressed sooner rather than later.