Physician's Coding Strategist-AHIMA issues standards of ethical coding
Are you doing it right?
Because of the continuing federal campaign against health care fraud and abuse, the American Health Information Management Association (AHIMA) in Chicago recently revised its ethics policy for coding practices.
AHIMA initially developed its "Standards of Ethical Coding" in 1991. The association says it revised the standards because of the increasingly important role quality coding plays in complying with regulations governing payment for health care services and in curbing fraud and abuse. The newly developed 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 coding conventions, official coding guidelines approved by the cooperating parties (see editor's note), the CPT rules established by the American Medical Association in Chicago, 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, 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 are con- flicting 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, those 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, resequencing, or inclusion of diagnoses or procedures when needed to more accurately reflect the acuity, severity, and 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 any 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.
(Editor's note: The cooperating parties are AHIMA, the American Hospital Association in Washington, DC, the Health Care Financing Administration in Baltimore, and the National Center for Health Statistics in Hyattsville, MD.)
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