coding insurance
A nurse is telling me that I should code what she wants me to without supportive documentation because it is for insurance. In all my years coding, I have never assigned a code without physician documentation. I need assurance that I am correct. We must have physician documentation regardless if it is insurance.
Need any advice on how to handle this.
Brenda Hoss
Coder
Need any advice on how to handle this.
Brenda Hoss
Coder
Comments
The home health record is a legal document. That is why the CoPs and HIPAA require that all documentation, including diagnosis coding, be accurate and compliant with current guidelines. Intentional manipulation of your documentation or coding for better payment would be considered fraud.
Susan Winokur, HCS-D, BCHH-C | Southwest Medical
Part of OptumCare
Senior Medical Coder, Home Health
8655 South Eastern Avenue, Las Vegas, NV 89123 USA
T +1 702-838-0644
Susan.Winokur@optum.com
smalv.com
For ammo, access your coding manual for proof of your coding guidelines and rules. As for insurance which is not a Medicare Advantage plan or a Medicaid Replacement ACA plan, you should ask this clinician if this insurance requires an OASIS. If it does then it most likely utilizes Medicare guidelines for its HH benefits like homebound requirement and therefore will require the same for its coding for the events billed. Tell her that under the Balanced Budget Act, HR 2015 Sec 4317, physicians are required by law to provide diagnosis information for MC and MA patients, and if this "insurance" utilizes the same rules, then the same applies. There is other information for you to back up your need to have physician documentation or proof of confirmation from the RN of diagnoses obtained for you to code meaning she must document it as information obtained directly from the physician, not just a message left in the physician's office with a sec'y.
Nancy Wolverton RN, CCM, HCS-D-10
Utilization Review Specialist
Kindred at Home
Little Rock, Arkansas
501-508-8526 (o)
501-690-2027 (c)
Nancy.Wolverton@kindred.com
I have never and will never code diagnoses without physician documentation and when I explain this to her I'll mention your first question.
Brenda Hoss
Coder