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You have been hired by a large physician practice to assign office visit and professional services coding

You have been hired by a large physician practice to assign office visit and professional services coding. Very early on you realize that component services are routinely billed with modifier 59 regardless of the documentation.

The office manager is not familiar with general coding guidelines. Her main concern is that claims are submitted timely. Her initial response is, “I do not care how you get it done; if there is an edit do whatever the system tells you to move the claim forward.” The providers also appear to show little interest in the documentation guidelines.

What is your responsibility in this situation?

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