CODING DEPARTMENT FUNCTIONS

1.Charge sheets that must be coded are, upon receipt by the billing account, forwarded to the coding department for diagnosis and CPT coding.

2.Medical coders code the diagnosis description given in the charge sheets according to established guidelines, using the ICD-9-CM (International Classification of Diseases, Revision 9, Clinical Modification, and Volumes 1 & 2) diagnosis coding system and CPT/HCPCS codes according to the procedure performed.. The published diagnosis/CPT coding rules under the ICD-9-CM/CPT coding system are observed.

3.Codes are selected strictly based on documentation provided by the client, and to the highest specificity as indicated in the submitted documents. When documentation is insufficient or unclear, the charges are returned to the client for clarifications.

4.Coding policies and guidelines, if any, established by the client, the coding supervisor, or insurer are followed wherever applicable during the process of coding.

5.When coders identify procedure coding or other errors in the charge information given to them, such errors are corrected with an explanatory note written on the concerned charge sheet. If the coding department decides that the errors are of such a type that will require client authorization or clarification, then such authorization or clarification is obtained from the client by the concerned billing account.

6.When a coder finds that the information on the charge sheet is insufficient to select the appropriate diagnosis or procedure code, the coder writes a note in the charge sheet stating what additional information is needed to supply the code.

7.When a given diagnosis code is not in the list of covered diagnosis codes listed in the state Medicare carrier’s LMRP (Local Medical Review Policy), the coder will code the diagnosis as documented and write “Not in LMRP” in the charge sheet. A policy can be arrived on handling denials by the operation team and client can be alerted on the same.

8.Coders, where ever possible, advise billing departments on the appropriateness of the diagnosis codes and procedure codes documented in a charge sheet, toward ensuring accurate health care claim submission. The clients are also informed of the same.

9.Coders should not alter codes or change information documented in the charge sheet, or any other medical document, unless authorized by the client, except when there are definite errors, such as typographical errors. No attempt will be made to alter the procedure or diagnosis documented by the physician or medical service provider. (See also point 6 above)

10.Upon completion of coding, the coded charge sheets are forwarded to the charge entry department of the respective billing account.

11.The work of new coders who join the department will be fully audited before file submission, until such time the coders gain the required level of accuracy.

12.A hundred percent audit of all coding work can be conducted during project transition, until such time the coders gain the required experience and accuracy levels.

13.Account specific coding policies, if applicable, will be documented