Reviews medical record documentation to assign codes to medical diagnoses, procedures and modifiers when applicable using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance.
• Reviews medical record documentation to determine all appropriate diagnostic, procedural and modifier code assignments. For hospital coding, reviews medical record documentation (i.e., provider orders) to code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding.
• Assigns and sequences diagnostic and procedural codes including modifiers using appropriate classification systems. For hospital coding, reviews all encoder edits and assign modifiers as appropriate for all HIM assigned Current Procedural Terminology (CPT) codes. Assigns and sequences diagnostic, procedure codes (minimal) and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and/or HIM Coding policies and procedures. Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Researches medical record for any additional diagnoses documented to meet medical necessity.
• Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
• Enhances and maintains coding knowledge and skills.
• Reviews all appropriate work queues daily to address edits and make corrections following procedures and processes.
• Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing).
• For physician billing, collaborate with billing department to ensure all bills are satisfied. For hospital, route to billing charge entry errors and/or account edits preventing completion of coding and/or billing. Make appropriate coding corrections when advised and follow procedure to notify billing.
• Communicate with insurance companies about coding errors and disputes (physician billing).
• Review and validate the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes.
• Submit daily productivity report to HIM manager by defined deadline.
• Meet and maintain HIM coding quality and productivity standards.
• Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.
• Performs all other duties as requested.