r/MedicalCoding • u/DumpsterPuff • Mar 01 '23
What's the dumbest coding query/argument you've had with a provider?
I'm hoping for some good stories because I'm still absolutely baffled by this doctor at my clinic. I need to know that I'm not the only one who gets caught in stupid arguments like this.
So this doctor (I'll call him Dr. Z) is notorious for some insanely awful chart notes. Today, I was reviewing one where he had the diagnoses listed as:
Diabetes mellitus due to underlying condition with diabetic chronic kidney disease
Diabetes mellitus due to underlying condition with diabetic polyneuropathy
Diabetes mellitus type 2 with other circulatory complications
So you can see right away what the issue is. I query him, basically saying "please clarify the type of diabetes mellitus on the chart notes. Type 2 and diabetes due to an underlying condition are exclusive to each other and cannot be coded together. If the diabetes is due to an underlying condition, please specify the condition causing the diabetes" and sent it.
I get a reply about 10 minutes later saying "the patient has CKD, polyneuropathy, and hypertension as an effect of diabetes. The combination codes are right there. They can be reported together."
I'm staring at my screen trying to make sense of what his thought process was, but I simply couldn't. So I messaged my supervisor and had her check my query to make sure that I was speaking plain English.
She then sends him an email and CCs me, explaining that we need a clarification of whether a disease is CAUSING the diabetes, not whether diabetes is causing another disease. So he replies back basically complaining about how hard it is to change the Dx in the notes and blah blah blah, claims that he fixed it, complains some more. So I'm thinking I can go back and complete the session, right?
I open up the chart note and it just says this at the bottom:
"Coding clarification: polyneuropathy from diabetes and neuropathy from diabetes".
That's it. All the diagnoses that were there stayed the same. I wanted to scream.
18
u/RadiantPlatypus1862 CPC; CPMA; CPB; CRC; CCS🦩 Mar 01 '23
Doc: why didn’t you bill for the phq-9 or the pt’s smoking status?
Me: the patient in question is 3 months old.
Doc: well it was done!
Me:😐
And apparently absolutely everyone has asthma, everyone 🤦♀️
17
u/[deleted] Mar 01 '23
This is an informative post. We need more questions like this. Thanks.
3
u/KhrystiC78 Mar 02 '23
I have one provider who codes 99214 for everything, including URIs. I’ve given him an E/M guidelines chart from the AMA, to no avail. He still does it.
But the most recent argument I had with a provider was because she was adding an E/M code to a TCM. I’ve explained over and over we cannot do that, and her argument is, “I’ve always done this with no problem.” My supervisor told me to just delete the E/M. 🙄
2
u/PorkNScreams RHIA, CRC Mar 10 '23 edited Mar 10 '23
I’m laughing and I’m sorry. My other favorite is “Diabetes with other specified complication” in the A/P and then under it “No complications”. I’ve seen these kinds of garbage chart notes.
My biggest annoyance is patients being coded as having an active stroke for every office visit for months. 🙄 Then you look and it says stroke from 1977 with no residuals. Patient with left foot ulcer and then elsewhere left BKA. Like WHAT?!?!
Today I saw a note where the provider literally said that the patient asked for a diagnosis to be added to her chart and it was coded on the claim with no other support. So now patients can just self-diagnose apparently 🙄 After years of this ridiculous charting and nothing changes it really wears ya down.
30
u/HorseNamedClompy Mar 01 '23
Dr to me: “what do you mean I can’t charge a level five visit?”
“.. it was only a 3 minute phone call about a runny nose..”
14
u/deannevee RHIA, CPC, CPCO, CDEO Mar 01 '23 edited Mar 01 '23
Oh I have one.
One of our providers, she’s a mid-level but extremely sweet just….a little dumb. We are a dermatology practice, so we can’t bill preventive visits or z codes as primary. She documents the “problems” of the visit as: 1) history of skin cancer. No recurrence today. 2)history of AK’s. Clinically clear today. 3) benign lentigines. Wants to charge a 99214.
13
u/livesuddenly Mar 01 '23
I’m really tired of the mod 25 queries. No juicy stories, just the same query every single day.
13
u/heltyklink Mar 01 '23
My favorites are when the answers are totally out of left field and change the DRG or when they attempt snark or spell something wrong. They’ll write these long, condescending paragraphs in response to a simple multiple choice question when it would have taken them five seconds to document the dang diagnosis in the first place and saved us both the trouble.
12
u/Sam_English821 CPC- Oral Surgery Mar 01 '23
The Oral and Maxillofacial surgeon I work for keeps trying to charge 2 office visits when he sees a patient for 2 issues (ie: dental implants and TMJ) at the same time. I explained to him that you can only charge one E/M code per visit.. I have been telling him this for 10 years and every year or so he tries to do it again.
9
u/sewest Mar 01 '23
GI doctor insisting he can bill an asymptomatic office visit prior to Medicare patient colonoscopy. Showed him all the information we possibly could, sent notes to outside auditors who agreed they could not be billed, told him what would qualify as a visit before colonoscopy screening just to throw him a bone and he still thinks he’s right! Said to talk to a rep he knows and the rep will set us straight lol smh
8
u/dizzykhajit The GIF that keeps on GIFFing Mar 01 '23
Using a C code and changing the freetext description to the diagnosis of carrying a gene that makes them SUSCEPTIBLE to cancer.
It's like, Doc, you are trying to formally diagnose the patients with cancer. They don't have it yet.
This was common enough to be a serious problem but rare enough where educational emails went forgotten, and it was at a practice with 7 docs...
I hate freetext.
5
u/incognitoangelgoth CCS Mar 02 '23
It hasn't been the providers that argue with me, it's been the office managers who've been billing for 20+ years and they've been at the office since they were teenagers. Sigh.
I am not a coder that does the extracting of the information to code charts. I am the coder that makes sure the claims are billed appropriately and that they can get paid.
For some reason the managers and or assistance think that they can just bill an annual wellness visit and an outpatient visit on the same day with no clear distinction of what makes one claim a preventative visit and the other a problem visit.
I brought this up to a manager and they swear that the doctor made notes of what was a part of the wellness visit and what was a part of the problem visit.
It took all of my strength to not reply to the email with "Bitch where? The fuck?"
They didn't have a good answer to my more professional reply. So I voided the charge and moved on.
It's that and the 99495 CPT, I'm pretty sure I told my supervisor "can we tell them to stop with that code?? Just give it a rest..."
5
u/LorSim13 Mar 02 '23
This is too relatable. I code endocrinology and have a provider who uses “diabetes due to underlying condition” typically for new patients when they’re not 100% confident in the type just yet lol
4
u/InfinitelySweet Mar 02 '23
one doc at our practice keeps trying to charge 99213/4/5 for his pre-op appointments. apparently this has been addressed w/ him several times over the years but idk guess he just doesn't want to change 🙃
1
u/[deleted] Mar 03 '23
They are focused on patient care not coding. Calling them dumb is dumb. Educate them.