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Click here for more sample CPC practice exam questions and answers with full rationale

Ethics Issue?

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

Medical Billing and Coding Forum

Ethics question/dilemma

I am curious/concerned how much responsibility falls on the CPC of a billing office, if an audit were to occur, where the practice owner has demanded claims be sent in and someone else coded them. If a CPC knew the claims to most likely be faulty in some way but that CPC’s name is not associated with them, could it legally come back on the CPC? The coder in question would not be certified. I know that ethically it would not be right to let the claims go w/o a fight, but legally/technically is there a problem that would follow the CPC indefinitely?

Thank you in advance for any advice, legally or ethically,

Tazlar

Medical Billing and Coding Forum

Medical Ethics Not A Dying Subject

As morals in medicine are on the decline, it is all the more important to uphold medical ethics in all circumstances. Health care and education are realized as the basic elements to ensure the survival of society into generations ahead. If their principals are not built on strong foundations to withstand the constant chipping away, it is likened to the foolish man who built his hand on sand and was washed away by the floods.

Solid principles in delivering health care services revolve around its code of ethics. Challenges may arise in the form of misuse or abuse of medications, procedures, treatments and other forms related to the field. Staff may be harassed or enticed to look the other way. Banking on the assumption of non involvement translating to innocence, the fact remains that knowledge without action is equivalent to condoning the act.

The role of medical ethics within its world of practice and study deserves due recognition. As such, morals in medicine should be a subject consistently extolled in the corridors and halls, drummed into the minds of health care practitioners of all status and levels. It is not sufficient for the general to be the only party aware of the enemys presence. The troops also need to be equipped to do battle.

As the world is a melting pot of cultures and religions, there is a need to understand the various styles of living so as not to overstep ones boundaries and cause a misunderstanding. A practice of medical service which may be acceptable to a people group may be taboo to another. Some religions do not adhere to blood transfusions. More radical ones may choose to not seek treatment as they believe in healing via means other than the hands of man. Hence, one needs to be sensitive in dealing with such situations as medical ethics dictates the saving of lives.

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