Coding, Classification and Reimbursement

Physician coder legal liability

  • 1.  Physician coder legal liability

    Posted 11 days ago
    I have been informed by an executive high up in my organization (who is a former coder) that, as a physician coder billing under the provider's tax id number (not the facility's tax id), once I have educated the provider and documented my coding advice, I no longer have any legal liability for improper coding and should just send through codes that I know aren't supported or that go against coding guidelines, because only the provider is liable at that point. This executive states that if I was coding for the facility under the facility tax id, I *would* have legal liability.

    I don't believe this advice from a legal standpoint and I definitely don't believe it from the perspective of maintaining my certification in good standing but wondered if anyone has information supporting it, or if AHIMA has a person who can answer the question about why this would put my certification in jeopardy.





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    Jessica Mulis
    Medical Coder
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  • 2.  RE: Physician coder legal liability

    Posted 11 days ago
    Edited by Julie Pisacane 11 days ago
    ICD 10 official guidelines has the following written; "a joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures .  These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses that are to be reported. The importance of consistent complete documentation in the medical record cannot be over emphasized."

    The above is found in the third paragraph of the guidelines.

    We share the responsibility. Ahima members also adhere to a code of ethics. There should  be a few references
    on this website that you can also share with the executive.

    Hope this helps.

    Warm regards,

    Julie

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    Julie Pisacane CCA,CPMA ,CPPM,CEMC
    Billing and Coding Specialist
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  • 3.  RE: Physician coder legal liability

    Posted 11 days ago
    Thank you, Julie. I agree, this has to be a joint effort between the physician and the coder. I located the code of ethics, thanks for the reminder.

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    Jessica Mulis
    Medical Coder
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  • 4.  RE: Physician coder legal liability

    Posted 11 days ago
    Hi Jessica
    I would also refer to the False Claims Act which cites it is illegal to knowingly submit fraudulent information for payment/reimbursement.  Additionally the OIG's website contains an immense amount of information to support your reasons/rationale for something other than the correct codes. And, ultimately there is impact to the patient as a result of submitting incorrect diagnosis codes.  Lots of tools at your disposal.  Good luck!

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    Lynn A. Wall, MBA, RHIT, CCS
    AHIMA Approved ICD-10-CM/PCS Trainer
    Interim Coding Supervisor
    Maricopa Integrated Health System
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  • 5.  RE: Physician coder legal liability

    Posted 11 days ago
    Thank you, Lynn. I checked out the OIG site and can't believe how much info it has. Good stuff.

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    Jessica Mulis
    Medical Coder
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  • 6.  RE: Physician coder legal liability

    Posted 11 days ago
    Jessica, I agree with your approach and the info shared above. Call me cynical, but I feel the executive just doesn't want to create conflict with the physicians by telling them they have to code correctly. The statement makes no sense. And I would bet he would not be willing to put his assertion in writing! You are wise to make sure you are protected and "covered".

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    Lorraine Papazian-Boyce
    President
    PB Resources, Inc.
    PB Resources
    Author, Pearson's Comprehensive Medical Coding: A Path to Success
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  • 7.  RE: Physician coder legal liability

    Posted 11 days ago
    Hi Lorraine, I agree...this is a case of trying to avoid conflict with the physician, and even if she was willing to put it in writing, I wouldn't follow it.

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    Jessica Mulis
    Medical Coder
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