Health Information Management

Coders need to understand their role in the process

HIM-HIPAA Insider, April 3, 2012

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Coding isn't just about reading documentation and selecting codes based on certain words. It's about processing information and assessing whether the codes reported accurately depict the clinical picture and medical necessity for an admission.

Coders are well versed in assigning a principal diagnosis, but less so in the concept of medical necessity, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS. They tend to simply code what's in the record rather than determine which conditions actually justify the services performed, says Krauss, an independent HIM consultant in Madison, WI. So why does this matter?
 
Omitting codes that capture medical necessity, some of which may be payer-specific, can result in denials, says Krauss. But reporting codes simply to satisfy medical necessity when physician documentation doesn't justify doing so can also be problematic, he says.
 
Editor’s note: Read the entire article in the April issue of Briefings on Coding Compliance Strategies.



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