What can you do if you believe your coder is coding incorrectly?

I am not a coder, but I do the billing for a cardiologist group. I truly believe my coder is coding the heart cath's wrong. The notes specifically state that the doctor did a coronary angiography and there is no mention of a cath being done. If the doctor does a left and right coronary angiography she codes a 93460... she has never used the 93454 CPT® code...

she coded 93460-26, 75710-26/59, G0269 for this procedure below...

1. Right common Femoral punture site w/femoral angio and attempted placement of a StarClose device
2. Selective left and right coronary angiographic evaulation
3. PTCA and stenting using drug eluting Promus Stents of the 2nd obtuse marginal branch

is this correct?

re: What can you do if you believe your coder is coding incorrectly?

93454 is already included in the 93460, thats why it says..."with Rt and LT"...
93460 includes everything done in 93454

re: What can you do if you believe your coder is coding incorrectly?

I am only questioning this because I was told by another coder that if the notes do not mention a heart cath being done then a heart cath code should not be used at all. Which is confusing to me... because if the coder is coding correctly then the doctor is doing medically unnecessary procedure, because the diagnosis is never allowed.

re: What can you do if you believe your coder is coding incorrectly?

[I am only questioning this because I was told by another coder that if the notes do not mention a heart cath being done then a heart cath code should not be used at all. Which is confusing to me... because if the coder is coding correctly then the doctor is doing medically unnecessary procedure, because the diagnosis is never allowed.]


Guess i would have to see the note, how else is he doing the angiography if he does not have a cath/sheath placed in the artery??

re: What can you do if you believe your coder is coding incorrectly?

He is using the sheath and this is the confusing part to me... if a cath/sheath is required to do the angiography then what is the purpose CPT® code 93454? Im sorry for so many questions about this I let someone get in my head and it freaked me out.... I never questioned it before because I knew the angio was part of the Heart Cath procedures, but then 93454 and 93455 seem like useless pointless codes.

re: What can you do if you believe your coder is coding incorrectly?

heres your cci edit
If you notice your RVU is higher for the 93460 thats because it includes the work of 93454.



93460 R&L HRT ART/VENTRICLE ANGIO M Non-Facility RVU: 38.65


No bundling issues exist
93454 CORONARY ARTERY ANGIO S&I M Non-Facility RVU: 27.28


****Code 93454 is a component of Column 1 code 93460 but a modifier is allowed in order to differentiate between the services provided.****

re: What can you do if you believe your coder is coding incorrectly?

Seek out a compliance person for guidance if you have one. If, you're comfortable talking to the coder do so, if not then go to their boss.

re: What can you do if you believe your coder is coding incorrectly?

I wish there was a LIKE button for your comment bsergi! :)

re: What can you do if you believe your coder is coding incorrectly?

http://www.ama-assn.org/resources/doc/cpt/17-cardiology-brin.pdf

re: What can you do if you believe your coder is coding incorrectly?

The first thing you should do is go to the coder most of us coders are quite approachable and are most willing to explain the rationale for our code selection. As a coder, I would be most appreciative of the professional courtesy of one addressing the issue with me first. You may also want to review the codes selection, documentation, and guidelines to determine if the codes are inclusive to one another prior to approaching the coder and if you still have question, just ask.

re: re: What can you do if you believe your coder is coding incorrectly?

I want to LIKE this comment also! LOL

re: re: What can you do if you believe your coder is coding incorrectly?

Unfortunately, our coder isn't approachable... She is the owner of the company. When I asked her about the 93454 and why she never used it, she took offense. When I have showed her codes that have expired and gave her a list of the codes that she had to start using, she got irritated at me. And yet she still codes procedures with expired codes...

re: re: What can you do if you believe your coder is coding incorrectly?

It sounds as if your coding has been outsourced? If this task has been outsourced and there is communication difficulties with the coder who happens to be the owner, and you have approached the coder and been unsuccessful with resolve or obtaining rationale, I would document the occurences and refer them to the practice administrator. You also seem to have a passion for research and discovery, you should become a coder sounds like you would be good and approachable. Best wishes!!!