Who’s responsible for the code?

Who Sets CPT Codes: Physicians or Coders?

Who is responsible for setting the CPT and diagnosis codes – the physician or the coder? Perhaps this question has arisen in your practice. It’s a controversial one.

Some coders believe that only they have the requisite education and expertise to do this – not the physician. Some physicians agree with this premise. However, physicians are ultimately responsible for choosing which code to use, so they are best advised to either work in direct concert with coders or code the services while remaining cognizant of coders’ advice.

Many consultants recommend that administrators require physicians to personally code every service and procedure, but you may not find agreement with this in the billing and coding industry.

Responsibility for coding aside, another issue you might have grappled with is where to find productivity standards for coding – the number of charts per hour or day. As with billing-office productivity, coding productivity should be measured wisely and with the understanding that each practice has a different payer mix and staff composition and assigns different responsibilities to its coders.