There are many different coding roles in the healthcare industry, and almost as many options for interacting with providers. The question of how much interaction do coders have with providers truly depends on the type of coding position held and the size of the organization. While the following is not a complete list of organization types, it is a good place to begin describing coder-provider interaction. 

Solo or Small Group Practices

These organizations either use a third-party billing service or employ at least one coder for every four or five active providers. Coder interaction with providers is usually daily, and may include provider education for annual codeset and regulation updates as well. Coders often wear multiple hats in smaller organizations, learning to effectively perform preauthorizations, benefit inquiries, insurance billing, and patient billing and collections services. Providers often have ultimate decision making authority over templates and EHR systems, if electronic systems are used. 

Solo providers are not common, except for dentists and chiropractors, as there is safety and support in multi-provider groups who can share call, have greater purchasing power for modern equipment, and create contract negotiating power with insurance payers. Small group practices are a great place for new coders to learn the ropes of coding without big production expectations and an opportunity to interact with providers to learn more about medicine and the specific provider specialty. Coders often have opportunities to ask providers questions, interact with them directly, and even have influence in template and documentation education, updates, and changes. Queries are not as common unless the organization uses an EHR system with query options. 

Multi-Specialty Clinics

These organizations either use a third-party billing service or have a medical coding and billing department, based on the size and quantity of providers who are part of the group. Experienced coders are a must for these organizations, as multiple specialties require specialized coding skills. EHRs are commonly used to generate patient medical records, which are then reviewed by coders to confirm coding that was assigned by the provider. While coders may have direct interaction with providers, often when larger quantities of providers are part of a practice, the coding manager becomes the main point of contact with the providers and either performs provider education or works directly with a provider-appointed physician who they educate on the annual coding regulation updates so they can, in turn, educate physician to physician. EHRs tend to include provider-query options, which are managed and overseen by coding managers. 

Outpatient Facility

These are large, hospital facilities employing numerous multi-specialty physicians and other qualified healthcare providers (QHPs) to treat patients in the outpatient setting. Outpatient facility coding involves ancillary services (e.g., lab, imaging), same day surgery, emergency department services, and clinic services. The difference between large clinic groups and outpatient facilities is that the hospital facility owns the building and all of the equipment so coding includes facility and professional services. Interaction with providers is less common than in smaller groups and is likely to occur through highly organized department heads or each specialty group may have specific coders they interact with, mostly through EHR queries. 

Inpatient Facility

Inpatient coding includes ICD-10-PCS codes, as well as HCPCS for supplies, and DRGs or Revenue codes. It is rare for coders to interact with physicians and QHPs other than as assigned by department heads. Often hospital systems have a hybrid of physician/QHP and coder educational programs that update providers on templates, coding regulations, and clinical documentation improvement (CDI) goals. 

Third-Party Billing Companies

These organizations often employ numerous coders and billers who may work within the same building, remotely, or a type of hybrid. It is very rare for coders employed by third-party billing companies to interact directly with the physicians/QHPs, as they are not onsite where providers practice. The billing company they are employed with may assign certain coders to maintain provider relations for coding queries and accounts receivable reporting, but generally, all communication is done through management or physician queries in the billing system. 

Remote HCC or Risk Adjustment (RA) Coders 

Most RA/HCC coders are remote and have little interaction with providers other than through provider queries. These coders review medical records to ensure all reportable, risk adjustable diagnoses have been captured and reported and are adequately supported. Provider queries are submitted through payer portals and responses are returned in the same manner. 

Tips for Provider Communication

According to Medscape Physician Compensation Report 2023: Your Income vs Your Peers, April 14, 2023, “Studies have shown that charting into an electronic health record (EHR) system can add up to 1.5 hours per day, beyond the physician’s regular workday. Overall, physicians spend 15.5 hours per week on paperwork and administration. Of that, 9 hours are on EHR documentation.” 

Considering the time providers spend on paperwork and documentation, it is important that provider communication is direct, to the point, and concise with useful takeaways and not just complaints. Providers need to know what they need to improve and why they should put the effort in to make the improvement. Money speaks, and time is money. If they can change a template and by doing so, the prompts within the template to document specific information each time they perform a certain procedure or service, and by doing so reduces the number of queries, improves coding outcomes, and prevents audits, then it is worth having the discussion. 

Be Respectful of Provider Time

A few recommendations for engaging with providers includes: 

When you request five minutes of the provider’s time, be sure to be concise in your presentation so that you can be done before the five minutes is up. 
When requesting providers make changes to documentation or coding, be sure to have an authoritative resource to cite and leave with them for review. 
If templates need to be altered to ensure prompts are provided for additional details needed to ensure high-specificity coding, be sure to provide an example of the template.
Coding guidelines and regulatory updates should be specific to the provider’s specialty and not a general overview. 

While coder experiences will differ from coder to coder, one thing is certain, that opportunities to engage with providers of all specialties is a privilege. These providers are educated on how to care for the human body but not often are they educated on how to document to secure reimbursement or how to accurately read and follow coding guidelines. That is the privilege and education we, as coders, have that can provide additional support to the organizations we are employed by.