AHIMA Releases New Standards of Ethical Coding
In an era of mounting pressure on health care organizations to comply with regulations governing payment for health care services and curbing fraud and abuse, quality coding takes on an increasingly important role. To ensure that coding practices adhere to the highest possible ethical standards, the American Health Information Management Association (AHIMA) has released its revised Standards of Ethical Coding in the March issue of the Journal of AHIMA. Developed by AHIMA’s Coding Policy and Strategy Committee and approved by AHIMA’s Board of Directors, these standards were revised in December 1999.
The newly revised standards are:
1. Coding professionals are expected to support the importance of accurate, complete and consistent coding practices for the production of quality health care data.
2. Coding professionals in all health care settings should adhere to the ICD-9-CM (International Classification of Diseases, 9th revision, Clinical Modification) coding conventions, official coding guidelines approved by the Cooperating Parties (AHIMA, Ameri-can Hospital Association, Health Care Financing Administration, and National Center for Health Statistics), the CPT (Current Procedural Terminology) rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets. Selection and sequencing of diagnoses and procedures must meet the definitions of required data sets for applicable health care settings.
3. Coding professionals should use their skills, their knowledge of the currently mandated coding and classification systems, and official resources to select the appropriate diagnostic and procedural codes.
4. Coding professionals should only assign and report codes that are clearly and consistently supported by physician documentation in the health record.
5. Coding professionals should consult physicians for clarification and additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record.
6. Coding professionals should not change codes or the narratives of codes on the billing abstract so that the meanings are misrepresented. Diagnoses or procedures should not be inappropriately included or excluded because the payment or insurance policy coverage requirements will be affected. When individual payer policies conflict with official coding rules and guidelines, these policies should be obtained in writing whenever possible. Reasonable efforts should be made to educate the payer on proper coding practices in order to influence a change in the payer’s policy.
7. Coding professionals, as members of the health care team, should assist and educate physicians and other clinicians by advocating proper documentation practices, further specificity and resequencing or inclusion of diagnoses or procedures when needed to more accurately reflect the acuity, severity and the occurrence of events.
8. Coding professionals should participate in the development of institutional coding policies and should ensure that coding policies complement, not conflict with, official coding rules and guidelines.
9. Coding professionals should maintain and continually enhance their coding skills, as they have a professional responsibility to stay abreast of changes in codes, coding guidelines and regulations.
10. Coding professionals should strive for the optimal payment to which the facility is legally entitled, remembering that it is unethical and illegal to maximize payment by means that contradict regulatory guidelines.
* For more information about coding in general and how it relates to compliance, visit AHIMA’s Web site at www.ahima.org.
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