This is information from the CFO of a large Multi-Specialty group in Kentucky.
We do allow our coders to change both the ICD-9 codes and the CPT codes. We have a protocol that divides the changes into three types or levels:
Level I – trivial change – e.g., adding an obvious 5th digit, switching codes when medicare requires a different code than commercial payers for the same diagnosis/treatment – mostly immunizations and other preventive services, etc. Coder just corrects.
Level II – significant change, but not affecting the level of charge – coder makes change and notifies provider.
Level III – change would alter level of charge. Coder makes recommendation to physician. If no response in 14 days or physician agrees, change is made. If physician disagrees, medical director intervenes.
This took a while to get running smoothly, but now works very well. We have a VERY compulsive compliance department and they have NO heartburn with the coders changing the bills.
