Medical Coding Accuracy 30227-HIM
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School
Southern New Hampshire University *
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Course
302
Subject
Medicine
Date
Dec 6, 2023
Type
docx
Pages
5
Uploaded by DrSeaLion3726
Holly Johnson
11/24/23
HIM-30227-XH099
Medical Coding
Accuracy 23DA08
Introduction of what medical coding is:
Medical coding is a series of numbers and letters that identify or describe conditions, diagnoses, or
tests that may be ordered or need paying for by a payee. This helps the payee identify what they are paying for.
This helps keep the medical system in order and compliance. Eight common medical coding errors could cause
improper billing.
●
Unbundling codes, or using multiple
CPT codes
for parts of a procedure
●
Upcoding
●
Failing to check National Correct Coding Initiative edits when reporting
multiple codes
●
Not appending the appropriate modifiers, or appending inappropriate
modifiers
●
Overusing modifier 22 — increased procedural services
●
Improper reporting of time-based infusion and hydration codes
●
Improper reporting of injection codes
●
Reporting unlisted codes without
documentation
(Dolbey.com.2023)
●
How might the specific coding conventions of the healthcare
nomenclature vary, and how might this impact the accuracy of medical
coding?
Coding conventions' nomenclature vary and impact the healthcare industry by
assigning number and characters to a specific deed. This affects the monetary
payouts for services in the healthcare system. This helps meet the guidelines
to satisfy what the provider or facility has to comply with the governing party.
●
Are there levels of subjectivity in the coding process?
Some levels are subject to a coding process: identifiers or labels. The classes are different per case.
For example, a young girl may have a right arm break assigned a code. Someone, another young
girl, may have a right arm fracture; these are two different code variations. A fracture is other
than a break and will be coded differently. This will need the use of judgment.
How might human error impact the accuracy of medical coding?
Incomplete or inaccurate coding are human errors that could lead to complications. This could cause an audit or
even cause the company or facility you’re working for to pay out fines for mishaps. Yes, there could be penalties
for submitting the wrong codes.
●
Describe key regulations that healthcare organizations must adhere to
to ensure accurate medical coding, and describe the impact of these
regulations on the coding process.
1.
Apply accurate, complete, and consistent coding practices that yield quality data.
2.
Gather and report all data required for internal and external reporting in accordance with applicable
requirements and data set definitions.
3.
Assign and report, in any format, only the codes and data clearly and consistently supported by health
record documentation following applicable code set and abstraction conventions and requirements.
4.
Query and consult as needed with the provider for clarification and additional documentation before
final code assignment, following acceptable healthcare industry practices.
5.
Refuse to participate in, support, or change reported data and narrative titles, billing data, clinical
documentation practices, or any coding-related activities intended to skew or misrepresent data and
their meaning that do not comply with requirements.
6.
Facilitate, advocate, and collaborate with healthcare professionals to pursue accurate, complete, and
reliable coded data in situations that support ethical coding practices.
7.
Advance coding knowledge and practice through continuing education, including but not limited to
meeting continuing education requirements.
8.
Maintain the confidentiality of protected health information in accordance with the Code of Ethics.3
9.
Refrain from participating in the development of coding and coding-related technology that is not
designed in accordance with requirements.
10.
Demonstrate behavior that reflects integrity, is committed to ethical and legal coding practices, and
fosters trust in professional activities.
11.
Refuse to participate in and conceal unethical coding, data abstraction, query practices, or any
inappropriate coding-related activities and address any perceived unethical coding-related practices.
(AHIMA.2023)
●
How might the organization use technology to enhance the accuracy of
its coding?
The healthcare software already has codes, which may help you be correct. It also holds patient information,
like religious preference, emergency contact information/next of kin, and hospital medical history.
How might the organization ensure its coding team uses the most current
coding conventions and all share the same understanding?
There are state and federal websites that will help you navigate through any processes you don’t
understand. There is assistance for the hospital/facility/ to make sure that its coding team is using
the most current coding conventions and that all share the same understanding. Usually, the
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software is designed to have imputed codes already in, and usually, if you forget something, it
prompts for the information needed to place a claim. The Joint Commission, Medicare, and
Medicaid work to ensure correct compliance. Some vendors will help with training and resources
that will help supply accurate information for your business or facility.
○
How can the organization ensure that it is prepared to address
current and future trends related to reimbursement practices,
quality-of-care initiatives, and data governance?
In the future, there should be regular audits internally. The focus should be on the areas that are weak and
need more attention. There should be regular participation from employees so that they will know what to
do.
●
Explain the importance of improving processes and ensuring accurate
medical coding and the repercussions of coding inaccuracies.
It is important that improvement is a goal because the goal generates money. It is also important
to maintain compliance to keep from being penalized by the governing parties. You want to keep
being accurate so that your vendors and payees keep your business going.
References:
8 most common medical coding errors | Dolbey Systems, Inc.
https://www.dolbey.com/8-most-common-medical-coding-errors/
bok.ahima.org/codingstandards
https://bok.ahima.org/codingstandards
Health Information Management: Concepts, Principles, and Practice,
Fourth Edition (snhu.edu)
https://eds-s-ebscohost-com.ezproxy.snhu.edu/eds/ebookviewer/ebook?
sid=d03d7a8c-06ef-4ee3-b5f4-8cfdf8888a7a
%40redis&ppid=pp_851&vid=0&format=EB
(13) Introduction to Medical Coding - YouTube
https://www.youtube.com/watch?v=nQPglo5RuQY