Who Has the CPT® Code Final Say?

medical coderAn article in the August 2015 Healthcare Business Monthly begins with this question: “Our facility is having a heated debate about who should have the final say on the CPT® code submitted for billing: the provider or the coder?” The answer to this question depends on who you ask. Let’s take a look at the two points of view discussed in the article.

“The providers’ argument is that they have the final say since it’s their National Provider Identifier (NPI) number listed on the claim, and if the billing is wrong, they are personally liable.

“The facility says coders have the final say, since they are the coding experts, and although the providers’ NPI is listed, the facility is ultimately responsible for billing compliantly. The facility reasons the coder is the individual who reviews the documentation and determines which code best applies to the documentation.”

Both points are valid and there does not seem to be a clear answer. This can create friction between the provider, facility, and medical coder. However, it also provides an opportunity to work together to assign the most accurate code.

The article goes on to suggest a solution to this debate: “Perhaps, through collaboration, the parties can work together toward a process that will result in both the coder and the provider agreeing on the appropriate code. Communication and education can resolve most disputes.”

When the physician and medical coder are willing to work together the accuracy of the submitted CPT® codes will improve.

For more information on this topic, review the article in the August 2015 edition of Healthcare Business monthly on page 60.

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