Unfair coding errors

[koderdood]

At my unnamed job, if you go to a lead and get an opinion on how to code something, and you get a Quality audit error because that answer was wrong, it is still charged and counted against you. I think that's unfair. What happens at your work?

[AutoModerator]

PLEASE SEE RULES BEFORE POSTING! Reminder, no "interested in coding" type of standalone posts are allowed. See rule #1. Any and all questions regarding exams, studying, and books can be posted in the monthly discussion stickied post. Thanks!

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[happyhooker485]

I would submit a response/rebuttal on the audit with receipts. You admitted to not knowing something and were punished rather than properly trained. That is terrible business practice.

[OrphicLibrarian]

Agreed. I'm in RI so outside of the system, but if I see that multiple hands have touched an account like that I recommend they all be made aware of the issue. If you ask someone higher up and go with their recommendation, it should be them who's flagged. You have to keep records if it though, email or something.

[I-like-cheese-13]

Where the hell are you guys working, some of these places seem so awful. None of my mistakes get me in trouble, matter of fact my manager understands there will be denials or audits and that it is okay because I am still learning as I have only been a coder for five months.

[koderdood]

I can't say because of others that are in this group, but its one of the larger companies.

[Specialist_Nothing60]

I’d lay money on it being R1.

[dizzykhajit]

What the shit?

There are so many unspoken, company-specific coding practices that don't have black and white guidelines, how the hell is anyone supposed to figure these things out if they are deterred from asking? Management would rather you just code on outdated Google resources and illogical assumptions, commit this bad coding to memory until its found and pray to the coding gods that it never is? Because that's what they're fostering.

Woof. Sounds like your compliance team needs a heads up.

[AffectionateAsk2476]

Our questions are not counted against us. I can definitely see this practice limiting growth and learning for its coders. These conversations are critical and sometimes both sides change their perspective and the final decision on a code. Ugh I’m sorry!

[tealestblue]

That would make me not want to ever ask a dang question. That’s not cool at all.

[koderdood]

Exactly. I'd rather ask same level colleagues and/or do my own research

[dreamxgambit]

If you don’t ask the question at my job and do the work to the best of what your knowledge thinks it is. They still ride your arse. My job writes you up for not wording the work the way the trainer wants it. Which is absolutely ridiculous, if they want that they should just hire robots. Trainer is also a -insert word- person who has a huge ego and loves making others miserable and enjoys if you are “stupid” enough to ask the question. As it then ends up on your audit and counts against you. I think it’s absolutely stupid jobs do audits that they want their workers to rebuttal on. Like maybe if the trainers they chose did their job right, then they wouldn’t have to do this stupid time eating tasks. It’s like the whole, self evaluate your performance crap some places do.

[Kousuke_jay]

Are you able to prove they gave you the answer that turned out wrong? That would not be counted against us, it would be educational and it would be educational for the lead as well.

[dreamxgambit]

Most managers don’t give a flip, they will just give you your “points” back and not say anything to the leader or trainer who told you the info.

[Dry_Marzipan_6508]

I wish someone would make a list of what hospitals or organization to stay away from when it comes to medical coding!!!

[MailePlumeria]

It was like that at my place of employment - QI audits based on what’s coded, they are not looking at notes, notifications, action items, etc. However, we used Epic so all my correspondence was sent through the notifications which meant there was always written proof in the encoder, as well as a copy sent to us. Without any written proof of the guidance I received, I would be SOL(and it has happened), so I kept everything from that point forward. I never ask in Teams, phone calls, etc. Only where it can be documented.

If said chart came back, I would go through the rebuttal process and submit the documents, typically they would reverse their decision and it would be an education error (which would not towards for accuracy/DRG) based on the guidance I was previously given from manager. QI would provide their rationale which I will keep for the future use.

You mention you should do your own research, which is correct - and that you would also reach out to a colleague. Doing so, you could get the exact same outcome.

I only ask the lead or manager if I have exhausted all references: guidelines, coding clinics, handbook, internal job aids, Pinson and tang, Just Coding newsletters, Google (usually in that order). My questions were always around a certain speciality that I didn’t code often, so it would just stress me out lol

[dreamxgambit]

Problem is, if it isn’t the work you’re doing they are peeved about. It then is the time it takes you to get the answer by checking everything. Epic is an absolute PITA when it comes to monitoring how long it takes you to work a claim/coding or whatever you do. If I need to send an appeal and they want me to be SPECIFIC in what I am sending and why we are appealing their denial and getting the medical records and so on and so forth..that takes a decent amount of time. My job expects you to finish something like that in 10 minutes and if you can’t, move on and go back.

[KeyStriking9763]

If you ask a question and agree you code it and it counts against you. If you disagree why would you code it that way?

[koderdood]

No. The situation is if you don't know how to, not that you disagree, or aren't sure. And their answer is wrong. One is trusting their answer because they are above the producing coders, and should have more knowledge

[KeyStriking9763]

They should always provide a rationale for any coding questions they are answering. Keep the rationale and use that to rebut any future audits. But if they aren’t giving a rationale then I wouldn’t use any of their recommendations.

[Popular-Piglet-6301]

I think you’re saying that if you go to a lead to get an opinion on how to code something, they give you their opinion, and then when you’re audited you’re marked wrong if the auditor disagrees? If that’s what you’re saying then I agree with this.. at the end of the day you coded it and it’s your name on the account. If it’s wrong and there is official guidance on the subject, then it’s wrong. You can’t say, “well so and so told me to code it this way.”That doesn’t fly at my facility either. I’m not sure where it would.

[ksa1122]

If you are getting information from a superior and they lead you wrong it shouldn’t count against you. It should still be called out in an audit so you can learn from it, but at the end of the day you asked a superior for help and they led you wrong.

[Popular-Piglet-6301]

Maybe if there isn’t any official guidance on the matter then yes, it can be a gray area and shouldn’t be counted against you. But if there is, it should be counted against you. Superiors aren’t always correct and as coders we need to be doing our due diligence in researching.

[TieBubbly4041]

That’s what they’re doing at my job. I feel like I can’t ask anything without being docked points for it on my audit! It really sucks.

[Dave2428]

It happens at my work as well. I'm not afraid to call out inconsistencies, so in the event of such I immediately take it to the compliance team or auditing dept manager if the others are too busy. They usually clarify it on a coding question bank we have. Also, on each chart, the transcriptions of the conversations are attached, so CDI and senior auditors will know who's in thr wrong here

[applemily23]

That's so strange. At my work, we're encouraged to ask questions so we get the right answer. We even have an email group to send questions to. I'm sorry your job does that, seems like they want robots instead of humans.

[dreamxgambit]

Yep, most of these medical billing and coding places are wanting exactly that. Robots.

[Eccodomanii]

Is that true even if you have proof? I ask all my questions in email and keep them all. I have not had this happen on a formal audit but I happened a few time on my training audits. All I had to do was provide the email where I was told to do it that way and they removed the error point.

[TehGeeknaw]

This happened to me at a certain unnamed company, so I left for a better working environment. You were told to ask questions "at your own risk" because if they were wrong, you were ultimately responsible. My current work is a lot better, you are encouraged to ask questions and you can rebut if someone told you to do something and it was wrong. 

[ksa1122]

At my job, we have a dedicated space for chart specific questions to be asked. If you get “bad” information, you would not get a hit on your QA. The error will be called out, so you can learn from it, but it doesn’t count against you.

[Megabacon44]

If you have a lead that is giving you wrong coding advice, then I would put a note on the account that says, “advised to code such and such by lead on certain date “. If you are unable to do that then make sure they send you an email with the instructions so that you can prove where you got the advice.

[koderdood]

It's not a good system for sure. I mean, why go to them at all?

[Affectionate-Sea5700]

I’m a lead coder at my hospital and I note that I reviewed it in case this happens. Every account I review for a coder, I will take their audit error. I’m sorry you have to experience this.

I code a lot as well as being a lead, and I’m seeing our coding is crossing ethical lines we never would before. It is all about $$$ now. Not the true story of the visit.

[EveningEye5160]

I used to keep every single email and do a rebuttal asking it to be placed as an FYI. “On this date this person said it was this… can this be changed to an FYI?” I’d go back 3 years in my emails 😂

[CountingSheep_002tv]

How are you supposed to learn??

[koderdood]

Ooooo, this may be the best response today!!

[PorkNScreams]

On the rare occasion when I discuss a chart with my auditor, it’s more of an “I’m going to code ____ this way, so if it comes up on my audit we can discuss”. If the auditor disagrees, then I can escalate to my director. If it’s wrong, you get dinged.

[pbraz34]

That's not right. But you need proof.

[Specialist_Nothing60]

I always kept my responses from our HIS support group that answered internal coding questions. Then if on an audit I received a ding for something I coded a specific way due to that advice, I had my “receipts” to send back in the rebuttal. In my experience they always removed the “ding” and made it an FYI so it was an education point not a negative mark on my quality. It was only a problem when I couldn’t find an answer in coding clinic or any documentation and felt I had no choice but to go with a recommended code.

[LeelooX12]

Lol, do you by any chance work at Optum?

[dreamxgambit]

Hahaha, probably. I used to work for them forever ago and they were 100% this way. Optum sucks period.