Melissa Smith is employed full time at a multispecialty health care provider’s office as a Coder I. Melissa is highly productive and accurate with her work, and she has received excellent employee performance evaluations. Melissa’s office manager asked to meet in a private office to discuss a patient complaint about a billing dispute. Melissa had coded this patient’s account.

This claim was denied by the patient’s insurance company because medical necessity for submitted procedures was not justified. The patient was seen for shoulder pain, for which the provider ordered a shoulder x-ray; however, the patient started having chest pain in the office while awaiting the results of the shoulder x-ray. The provider immediately took the patient’s vital signs and ordered a chest x-ray and an EKG to determine whether the patient was having a myocardial infarction. Fortunately, both the chest x-ray and EKG were negative. The shoulder x-ray results were also negative, and an exercise stress test was scheduled for the next week to further investigate the cause of the patient’s chest pain.

The patient was prescribed ibuprofen 800 milligrams, to be taken every six hours for shoulder pain.

Upon review of the submitted claim, Melissa and the office manager determined that the shoulder x-ray, chest x-ray, and EKG procedures were properly coded and reported; shoulder pain was appropriately coded and reported for the shoulder x-ray. However, shoulder pain was erroneously reported for the chest x-ray and EKG. They agreed that Melissa would submit an amended claim to the health insurance company to correctly report the chest pain code for the chest x-ray and EKG procedures.



What should Melissa's office manager do in order to ensure that this does not happen again?