We had a visit from the ladies in our groups’ coding department the other day - with the scary news that Office of the Inspector General (OIG) has appointed some 1,600 auditors.

This whole business of trying to decide what your service is worth, and what charge code you should use is something that was alien to me when I first hit the U.S - coming from a country with nationalized health where you are on a salary. Where you don’t have to sully your hands with money or charges.

How much should I charge for looking at your throat or checking your prostate or supervising your diabetes? There are of course criteria for deciding what you should charge, ranging from 99211 to 99215 for an established patient - and insurance companies pay more, according to a set fee scale, the higher the code.

But still there is a certain amount of maneuverability. Room to “buff” the chart and put in a bunch of not strictly relevant detail about medical history and exam that allows you to charge more.

The advent of electronic medical records (EMR) - i.e. writing all ones notes on the computer - is a whole new opportunity for buffing. We have ‘Next Gen’ EMR. This carries forward any information you already have about the patients previous medical history, family history, social history etc, which makes it a piece of cake to put in enough information to justify a 99214 or even a 99215.

Then you’re stuck with this ethical dilemma. You can charge a higher code, but knowing in your heart of hearts that charging a 99214 for treating someone’s sinus infection is a bit of a con, then should you? Is it OK to charge whatever you can get away with?

OIG to the Rescue

So now, even here in the “land of the brave and the home of the free”, big brother is stepping in - except that ‘Inspector General’ conjures up images of my mothers’ favorite movie and Danny Kaye playing the fool in the 1949 movie “The Inspector General”.

But we have to watch our backs for these 1,600 auditors - who are incentivized by “being paid a percentage of the money they recover” according to our coding department. There must be too much “buffing” going on - or at least the OIG believes that, to turn the hounds loose.

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