Establishing a Physician/Coder Relationship Is a Must do in Today’s World

Thursday, July 2, 2020 | Joline Bruder

Picture this, the year was 2003 and I was a newly certified coder working in a medium size cardiology office. After working for four years gaining experience in coding, we merged with a three surgeon cardio-thoracic practice. The practice needed a surgery coder and I landed the position.  

So, I packed up my coding books and left the comfort of my fellow coders and headed to the new office. I was a stranger in a strange land, very similar of when I was 21 and in the Navy. I stepped off a plane in Prestwick, Scotland heading to my new home, the USS Simon Lake. I survived that, so I would survive this.

The problem was, no one in our area had ever coded for cardiac surgeons; they had been using a billing company in another state.  What was I to do? Talk about going from the frying pan into the fire! From there, my practice sent me to a non-competitive group for a short introduction to learn about CT surgery coding. Not exactly the best scenario, but better than nothing. I also attended a coding conference to gain more knowledge.

However, the most valuable thing I did was become friends with the surgeons. After all, surgeons are humans too and while I had the utmost respect for their positions, titles and knowledge, I refused to be intimated by them. That doesn’t mean that we hung out on a personal level, but I did sit down with each one of them and got to know them a little bit. They knew I was a fish out of water and needed help. I explained that we were on the same team and I wanted to ensure that they were being reimbursed correctly for what they performed. Out of the three, there was one who was younger, more receptive and had been through some coding conferences himself, so that’s who I latched on to.

Gaining Knowledge and Experience

As the op reports came flying in, I began coding the easier ones first, which gave me confidence. When I got to the harder procedures, I looked through my books, reached out to my resources and coded away. When I finished those reports, I set aside time with the physician and would gather up my books and show him. I would say, “This is what I think was done, and this is what my books say, now tell me if I’m heading in the right direction.” He would gladly go over it and tell me “yay” or “nay.” He also patiently explained, in English, what the procedure was, and that is how we progressed.

As I gained more experience and knowledge, he and his colleagues started to trust me more and we became more like teammates. Now don’t get me wrong, there were missteps and mistakes made because again we are all human. But as the weeks and years rolled by, I was like a 5-year-old soaking up knowledge wherever I could!  They even invited me to witness procedures. Talk about painting the picture! Cardiac surgeries became my passion.

Later when we added vascular surgeons, I was already a pro at establishing relationships so that was much easier. Once when I had an issue, my CFO stepped in and talked to the vascular physician. She adlibbed a quote from “Finding Nemo,” and said, “Remember doc, coders are friends not food.”

Physician Benefits

The physicians reading this are probably wondering, “So how does this benefit me?” I will tell you, if you give some of your time to your coder several things can happen. First and foremost, your claims will go out cleaner and you will get reimbursed properly and more quickly. Your coder plays an important role on whether you are getting paid appropriately for the work. A good coder will cover his/her own salary 10 times over and a bad one will cost you major dollars. But the best part is that once you have that good relationship, your coder can provide you priceless feedback on how to improve your documentation, so coding is more accurate. The more accurate the coding, the less risk you have for an audit. They will also keep you up to date on the ever-changing Centers for Medicare & Medicaid Services rules. If you don’t have a good relationship with your coder, you could find yourself on the wrong side of the process, and no one wants that! Also, you may learn something, and they definitely will.

Coder and Physician Responsibilities

Like any good relationship, each side has a responsibility to the other. Here are my tips:

Coders:

1. Be Honest – Nothing ruins a relationship faster than being lied to. Ensure you are giving your physician the most correct, up to date information you have. When you are wrong, own it.
2. Don’t Guess – Tying into number 1, if you don’t know the correct answer DO NOT guess. Be honest, tell them you don’t know but you will find out! They will test you too. To earn their trust, back up your answers with proof.
3. Ask Questions – This ties into number 1 and 2. If you are unsure of something that a provider dictated, ask them. DON’T ASSUME.
4. Provide Constructive Feed Back – Don’t just focus on what’s wrong with the documentation, commend the provider when they are doing something right. You must provide feedback though or the documentation will never change.
5. Schedule Meeting Times with Your Physicians – In the middle of a busy office day is probably not the best time to go ask questions. Talk to the nurse or scheduler and make an appointment. If something can be done by email or other form of electronic communication, use it.
6. Keep it to the Point – Have your thoughts/questions organized. Remember physicians are extremely busy and like you, they don’t want their time wasted.

Physicians:

1. Be Receptive and Have Patience – Remember your coder is there for you and wants to do things the right way to benefit you and the practice. “Coders are friends not food.”
2. Ask Questions – This will help make sure you are documenting correctly, DON’T ASSUME.
3. Allow Coders in your Cath Labs and Operating Rooms – Honestly, the best way they can learn is to see. Obviously, there are facility rules to follow and patient consent and you can’t traipse 10 coders in at once.
4. Respond in a Timely Manner – If your coder asks you a question, respond in a timely manner, so they aren’t holding on to 50 claims because they are unsure of something.
5. Invest in Your Coders’ Education – I know budgets are tight (especially these days) but if your coders can’t access coding conferences or webinars, it will be impossible for them to keep up to date. My surgeons fought hard to keep my education in the budget, and they won.
6. Appreciate Your Coders – Let them know that you do value their job and their knowledge, after all we need each other in this business.

Final Thoughts 

One of the most important relationships in a practice is between a physician and coder. All too often I see where that falls through the cracks. The benefits are endless to both of you, and who knows, you may gain a forever friend. I’m still friends with my surgeons today and we still learn from each other.

Learn more about the MedAxiom Consulting Team and how we can help you and your organization tackle issues such as revenue cycle management, patient access, staffing/operational efficiencies, adaptability and more.

Illustration: Lee Sauer

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