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.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.