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Discussion

Help: being asked to do my own coding, never been trained for it

I work for a small non-profit clinic inside a large social service agency, in an urban area. I've only been an RN for a year. This clinic receives federal and county funding as well as grant money.

When I was trained to do documentation, I was instructed to use a "cheat sheet" that was made in-house that contained ICD-9 and V-code that weer supposed to match up with the things we commonly do. I played along until I was recently sent to a coding course specific to my job, and discovered some disturbing news. Keep in mind I've only been a nurse for a year and never even heard of ICD-9 or coding until I started here.

At the coding training I attended, I was shocked to discover that all the other nurses there had a coder or coding department in their clinics. They, in turn, were shocked to find out that I was being expected to do my own coding without ever having been trained for it. I showed the instructor my "cheat sheet" and they said most of the codes were dead wrong and/or outdated and inappropriate. Incorrect coding is a threat to both patient safety and liability of our practice and licensure. It also greatly affects our data, which determines our funding.

I came back from the training with lots of ideas and eager to share what I'd learned. Since then, everything I've said has fallen on seemingly deaf ears. No one seems to want to listen to me or deal with this. If they are donig anything about it, it's happening behind closed doors and I have not been invited to give my input. At one point, an administrator even "fixed" the "cheat sheet" and it was STILL totally wrong.

I've since picked up an Easy Coder book. If I'm being forced to perform a job I've never been trained for that puts my license on the line, I'm going to at least make an attempt to do it right.

Does this sound nuts to any of you?

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Nuts, yes. Believable, yes!

Where I work, the cardiac cath lab staff has been assigned the task of "billing" for the procedures done. But to bill correctly, one has to know the appropriate coding rules. "Cheat sheets" were given, but there are so many permutations in what's done during a case that it can be quite time consuming to find the appropriate combination codes. And who can they turn to if they have questions about how to do correctly? The two coding books that were provided to the lab. Clear as mud sometimes. So who is checking if they do it right? I can't get any straight answers on that. But I think it's ridiculous to give that responsibility to the clinical staff! I'm sure it's a matter of budget constraints and the incorrect thinking that "oh, this little extra chore won't take more than minute." Yeah, right! It will probably take an audit with penalties to convince administration to budget for more dedicated coders.

I know nothing of this except to say that people have been charged with fraud for improper coding. Tread carefully.

oramar is absolutely correct!!!

According to the new Federal regs - anyone who knowingly participates (or does not try to stop) fraudulent billing practices is equally guilty - and this is a Federal Rap! Very little leniency.

At the very least, people caught up in these things are placed on the 'sanctioned' (do not hire) list of providers who are not allowed to work with any federally subsidized programs (medicare, medicaid, etc). It could be a career ender.

Talk to your designated corporate compliance person... and document the fact that you did so. If you can't get them to correct the problems, go get a new job and turn them in. Whistleblowers, are entitled to a reward - percentage of the fine/judgement against the provider.

Look after yourself!!

  • Author

One of the things I'm really worried about it the legality of this. I've never been trained in coding, (never even heard of it til I started working here) and I'm being asked to essentially do it on the fly. Seriously, some days I sit there with the Easy Coder book and just "guess" about which codes fit situations. It feels wrong beyond belief.

I know that codes can determine LOTS of fates for patients, and in this litigious society we live in, I'm scared to death that it's going to take a LAWSUIT or someone being harmed as a result of incorrect coding. Mostly, I'm starting to get really freaked out about my OWN license being on the line like this. It's becoming more clear every day that something is really, really wrong around here.

Since I'm so new to nursing and new to the agency, I don't have much "pull" around here and already I'm not being taken seriously. This has made me very uncomfortable and leery of talking any more about it to anyone - even my boss. So thanks, anyone who replies to this. Any and all ideas or thoughts are really appreciated.

  • Author
oramar is absolutely correct!!!

According to the new Federal regs - anyone who knowingly participates (or does not try to stop) fraudulent billing practices is equally guilty - and this is a Federal Rap! Very little leniency.

At the very least, people caught up in these things are placed on the 'sanctioned' (do not hire) list of providers who are not allowed to work with any federally subsidized programs (medicare, medicaid, etc). It could be a career ender.

Talk to your designated corporate compliance person... and document the fact that you did so. If you can't get them to correct the problems, go get a new job and turn them in. Whistleblowers, are entitled to a reward - percentage of the fine/judgement against the provider.

Look after yourself!!

Thanks - any idea where I can find these new Federal regs in writing? I googled a bit for it, but if you know a really good source please share.

the really stupid part is that the bean counters in your facility may not be collecting maximum benefits for the work all of you do. That is a sales point to the Medical Director, I would hope.

For starters, if the office you work for bills medicare/medicaid, they are supposed to automatically get some newsletter - I think it's every month- from them. It's ridiculously complicated to read but it contains changes and is invaluable to coders.

Second, I feel your pain. I started doing the coding thing, without training, in 1991. Holy crap, it was like trying to read the encyclopedia after it had been stuck in a Ronco Spaghetti Twaddler. Talking the office manager (doctor's wife) into buying new, updated ICD9 and CPT books was a full time job for like, a month. Once I dug out her medicare newsletters and started actually making them some money it got to be a bit more fun.

Note: by making money I mean, they were finally getting paid what they should have been getting paid. The hard part is getting the clinic's providers to actually document what they say they did, so that the coding is actually legal. It's like trying to talk cats into barking. And yeah, I went to one of the medicare conferences once; talk about intimidating, but it did help. The thing that helped the providers of my clinic to actually do proper documentation was when the state medicaid people audited some charts and took some money back. :-)

Question to the OP: what is your license? Nurse? Because there is no way in heck that you could pay me now to do that job again. I tell my psych patients that I got out of billing/insurance to save my sanity and they agree with me!

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