Medical Coding and Documentation inaccuracies result in missed revenue and reduced cash flow for healthcare organizations and to avert such situations Auditing and Compliance specialists reg
Part 1
Medical Coding and Documentation inaccuracies result in missed revenue and reduced cash flow for healthcare organizations and to avert such situations Auditing and Compliance specialists regularly conduct validation reviews.
What these specialists look for in the medical documents? How they ensure synergism between the medical documents and ICD/CPT codes? How many medical documents they review as a sample? Why is that so? How do they resolve coding mismatch situations? What could be the consequences of lack of the validation programs on the healthcare facility’s financial health? Would it have impact on the facility’s accreditation status also?
Part 2
Watch the YouTube video on https://www.youtube.com/watch?v=rKnj0OrZnSAICD-10-CM Guidelines and conduct the following activities individually for self-check. After that offer a reflection on the experience on the learning activity in the discussion. Do you think the job of Auditing and Compliance Specialist is boring? Exciting? Stressful? Other?
1. What do the ICD codes represent?
2. What is the purpose of ICD-10-CM?
3. What are various ICD-10-CM sections and how are they labeled?
4. What is meant by “Conventions” for the ICD-10-CM?
5. Where would you start looking for the ICD-10-CM code?
6. What are the “format” and “structure” of the ICD codes?
7. Where is a placeholder (X) used with the ICD codes?
8. What do the “NEC” and “NOS” abbreviations represent in ICD-10-CM?
9. What is “punctuation” and its “types” in ICD-10-CM and where are they used?
10. What do “Include” and “Exclude” explain in ICD-10-CM?
11. Which condition should be coded “first” if multiple medical conditions exist?
12. What do the “AND” and “WITH” indicate in ICD-10-CM?
13. What do “See” and “See Also” mean in ICD-10CM?
14. What are “Default Codes” in ICD-10CM and what do they represent?
15. Which statement of the provider documentation determines the code assignment?
Offer a reflection on the experience on the learning activity. Do you think the job of Auditing and Compliance Specialist is boring? Exciting? Stressful? Other?
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