I’ve been sending my provider 3 encounters, one for how many lesions she did cryo on (document states 5+, when I emailed to ask, she stated 4, asked her to add addendum to state that), and the other 2 were for trigger point injections (she stated 10 trigger point injections were done, but did not state how many muscles were involved). These have been outstanding since November and I send her an email at least once a week for her to fix it. My supervisor gave the other coder in my team these encounters to review and accept the charges… other coder accepted the charges as is and the provider never corrected her documentation… These were accepted 01/09/2019… these visits were for end of November/Middle of December… I’ve been coding for 5 years now, but I’ve never ran into an issue where the provider does not add what little documentation I request, or a practice that submits claims where the documentation doesn’t match the codes. I was also not told that the other coder would be taking on these encounters… and when I went to follow up on them, I saw they were already accepted and on their way to the insurance.

Is this normal for other practices to just go with what the providers have entered although their codes chosen doesn’t match the documentation requirements and definitions?

Thanks for the help,
L