I work for a billing company, and one of the clinics that I code for has recently started to perform a new procedure in the office. Prior to beginning this, the office manager emailed me regarding the suggested coding that was provided by the device manufacturer. In my professional opinion, this code was not fitting AT ALL, and I suggested that they use an unlisted code. I explained this in every way I knew how, and the manager/doctor refused to listen. They performed this procedure for the first time on Monday, and sent me the note yesterday. I then emailed the office manager again and explained that we CANNOT use this code, and asked if she wanted me to proceed with the proper, unlisted code. She then stated that they wanted to use the coding recommended by the manufacturer.

I feel extremely uncomfortable submitting this claim that I know will be fraudulent. The office even made the procedure note documentation match the CPT code that they are wanting to use, when in all reality it was not what was done. I explained to my employer that I would be putting myself (certification) at risk by knowingly submitting false claims and I was not going to do that.

What would you do to "cover yourself?"

Elysia York, CPC