When we create claims through our EHR (eClinicalWorks), the claim is a "snapshot in time" … it pulls the coding from the chart and generates the claim. When there’s an issue and the coding needs to be changed, it’s easy enough to correct the claim and submit/resubmit. However this only corrects the claim — the "chart" still contains the original coding. Because of this, we go the extra step to correct the coding in the Progress Note as well. I’m told this is because of concerns that an auditor would see a discrepancy between the chart and the claim. My concern is that we may be doing extra work that’s not necessary.

Sometimes this happens prior to claims going out – it could be something simple like dx codes sequenced incorrectly. Or maybe a code was left off like 90460 for vaccine counseling. An extreme example might be that the provider used an established patient code and they are a new patient (or vice-versa).

Sometimes this occurs when a claim is denied. We have just one HMO that wants infant Well Visits to use codes Z00.110 and Z00.111 … all others want Z00.129 … so this gets missed on occasion. In this case, it’s been a week or more so the charts are locked. We can correct and resubmit the claim easily but we have to have the provider unlock the chart and change to the dx in the Progress Note. I hate bothering providers for this and I feel this is only an EHR quirk … if we had paper charts and a SuperBill you wouldn’t go back to the provider and say "I need to line out this code and draw a circle around this one" would you? The chart has a proper Well Visit dx … just not the one this carrier wants to see.

Of course this is an EHR so there are logs to provide an audit trail to show who changed what. Wouldn’t that be sufficient to explain any disparity?

My question is… Is this extra work necessary and/or prudent? Opinion please – prudence or paranoia?