Coding, Classification and Reimbursement

Adjusting E/M code of a encounter in outpatient setting

  • 1.  Adjusting E/M code of a encounter in outpatient setting

    Posted 01-22-2019 09:00
    Hi

    A few of our providers are having issues with E/M coding. In many locations a coder vs a provider identifies the E/M code that will be assigned to an encounter. I am curious to know if it is allowed that a coder can go into a encounter and adjust the E&M code for claims submission or is this not allowed once the provider has selected a code (which often is incorrect).

    Thank you in advance for your feedback.

    ------------------------------
    Janet Norton
    Clinical Documentation Specialist, Coder and Train
    ------------------------------


  • 2.  RE: Adjusting E/M code of a encounter in outpatient setting

    Posted 30 days ago
    Our providers have requested to have certified coders assign the E&M levels which I totally agree with their choice.  In the past I have seen providers assign an E&M level after the visit and before the note is dictated.  I called it "dart board" coding.  Now the E&M level is actually assigned by someone with knowledge of the requirements and is based upon the actual documentation.  It is a win-win situation in my opinion.  Let the providers practice medicine which is their education and let the coders code which is their education.  I believe this issue has been discussed previously on this community with some for and some against.

    ------------------------------
    Nelda Laskey RHIT
    Coder/RAC Coordinator
    Kearny County Hospital
    ------------------------------



  • 3.  RE: Adjusting E/M code of a encounter in outpatient setting

    Posted 17 days ago
    I agree with letting the Certified Coders code the E/M or adjust the E/M and the diagnosis. We have the education/coding knowledge. I was also taught that the coders would be responsible for what is submitted, so your credential/credibility is on the line. This is why we must continually educate ourselves in this field. Physicians are not given an extensive course in coding so I wouldn't always agree with what they submit.

    ------------------------------
    Robin Hogue
    Outpatient Coder
    ------------------------------



  • 4.  RE: Adjusting E/M code of a encounter in outpatient setting

    Posted 29 days ago
    I don't work with E/M but have asked that question during a Colorado Coding Coffee Chat and it seems each practice handles it differently.  Therefore, I don't think you'll find a written rule.

    For the circumstance where the provider assigns the code and the coder verifies or changes it: if it's changed, the provider is notified of the change and the rationale. Call it education.

    I completely agree with the comment to let the physicians treat the patient as is their training and let the coders code.  But a combination may actually result in a better understanding by both parties.

    ------------------------------
    [Dorothy "Dotsy"] [Baxter] RHIA CCS
    [ICD-10-CM/PCS AHIMA Trainer Certificate holder]
    ------------------------------



  • 5.  RE: Adjusting E/M code of a encounter in outpatient setting

    Posted 17 days ago
    ​It is within a coders scope of practice to select E/M levels either initially or adjust it after selection by a provider. It is appropriate to makes changes before the charge leaves the organization based on supporting documentation. Coders cannot alter the medical record so it would depend on how your system is setup of capturing charges and if your organization calls for the provider or coder to have the final "say".

    I have worked in systems where the charges are not apart of the medical record which is easier for coding changes and there are systems that have them built in which may require the provider to make changes because it alters the medical record.

    ------------------------------
    Leticia Selmon
    Ambulatory Coding Manager
    Children's Minnesota
    ------------------------------



  • 6.  RE: Adjusting E/M code of a encounter in outpatient setting

    Posted 17 days ago
    Thanks Letisha!   Do you know where a statement of our scope of practice is written?  I agree it's being done, but for anyone who is getting push back, this would be helpful.  

    --
    Thank you,

    Dotsy Baxter
    719-276-5082








  • 7.  RE: Adjusting E/M code of a encounter in outpatient setting

    Posted 17 days ago
    Dotsy there is nothing legally published with that statement. I would utilize the coder job description from your organization, the AHIMA code of ethics for our profession and the I10 Coding guidelines (page 1 3rd paragraph). These all support it is within a coders(credentialed) scope of practice to make coding changes that is supported by documentation whether it is e/m level changes or diagnosis changes to highest level of specificity.​

    ------------------------------
    Leticia Selmon
    Ambulatory Coding Manager
    Children's Minnesota
    ------------------------------