Medical Coding Dilemma Faced by Physicians And Medical Practices

Who Should Code????

There has always been a raging debate in the medical community as to what constitutes a proper medical coding workforce.  Is it best left to the physicians and surgeons, who already are stretched to their limits in their typical workday?  Should nurses or PA’s take up this responsibility primarily?  Or should one follow the general industry trend, in the form of certified coders and billers.  The surgeons and physicians would contend that coding comes under the umbrella of “business aspects of medicine”, and thus should be left to the specialist billers and coders.

The Middle Path

Once the founder of Buddhism, Gautama Buddha was meditating in the Himalayas after abandoning life as Prince Siddhartha, trying to find means to end suffering in the world.  Legend has it that Buddha believed that the extreme exercise of complete fasting, wherein he ate only 1 grain and 1 sesame seed per day, would free him of all desires and hence suffering.  As time went on he became so thin such that he was able to touch his spine by feeling his abdomen, and could no longer concentrate on his meditation.   It was then that he accepted to consume a milk porridge given by a herds maid, and subsequently regained his strength for meditation and went on to achieve enlightenment.

The Coding Middle Path

If clinics are to attain medical coding Nirvana, a middle path wherein the knowledge of doctors as well as the expertise of expert coders is utilized, should be adopted.  There are instances wherein clinics have been fined $10,000 per line item for not adhering to medical coding ethics.  The sight of a surgeon going into the operating theater carrying a CPT coding manual does nothing to inspire confidence in the minds of the patient community.  Also you cannot expect a surgeon or physician to keep up with the latest coding updates, CCI Edits, bundling rules and what not by attending a yearly once medical coding refresher course.

The Medical Coding & Billing Vendor

It has been an empirical observation in the medical billing industry that synergy between a vendor and a clinic produces better billing outcomes than if the clinic were to operate alone.  The vendor with his state of the art coding software, certified coders and billers, dedicated support personnel, and continual educational programs, stands a better chance of getting that claim reimbursed than a typical in-house billing team.  Moreover, it has been seen that the in-house billing team would better fit the role of an interface between the doctors and vendors, in making sure that each service coded matches the physician’s diagnosis to a tee.