chapter 10 reality check billing and reimbursement

Coding Guidelines are the foundation for all fair and accurate coding practices around the United States and world. While all coders love to have all the guidelines written clearly in black and white, there are many gray areas that leave room for much discussion. This is where new coders often over code, under code, unbundle, bundle, code too much, or too little. If you’re an outpatient coder, for example, you quickly learn you can’t code anything a provider states with the words ‘likely, should be, would be, could be probable, etc.’ Coding Guidelines are the key to a coder’s success, and the key to a successful practice!

When Tammy started coding, she paid attention to every detail in the patient’s chart. She followed coding guidelines and coded only those conditions that were medically managed. Tammy’s coding department was under a lot of pressure to code high volumes of charts. In order to save time, sometimes Tammy coded a diagnosis that that did not necessarily support a procedure, and at times she unbundled services. While it wasn’t an intentional attempt to commit fraud, Tammy was committing fraud.

If you were the coding manager of Tammy’s department, discuss how you might avoid these fraudulent events.

Put your comments in a word document, I’m looking for between 2 and 3 paragraph

 

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