You are the health information manager at Lower Mountain Hospital. An auditor recently visited the hospital and found multiple errors in your ICD-10 and CPT coding. Below are some examples of the errors the auditors identified:
- In many instances, the “code first,” “use additional code,” and “code also” conventions for ICD-10 were not applied.
- The level of detail in ICD-10 coding was not sufficient.
- The CPT modifiers were used inappropriately, and procedures were unbundled unnecessarily.
- The codes for the principal diagnoses (ICD-10) must directly relate to the treatment procedures (CPT) performed, and mistakes in alignment between the two were found.
As a result of the auditor’s findings, the board has asked that you evaluate Lower Mountain Hospital’s current coding processes and recommend approaches to improve coding accuracy. You will present your evaluation and plan to the board.
Directions.
As the health information manager at Lower Mountain Hospital, you will create a coding process improvement report to present to the board, in which you evaluate current processes.
- Current Processes: Review medical coding practices to determine some common coding errors that may have contributed to the inaccuracies at Lower Mountain Hospital, provide reasons why these errors occur, and identify key regulations and coding conventions that must be followed to ensure accurate medical coding in healthcare organizations.
- Describe some common coding errors that may have contributed to the inaccuracies at Lower Mountain Hospital, as well as the reasons for these inaccuracies. Consider the following:
- How might the specific coding conventions of the healthcare nomenclature vary, and how might this impact the accuracy of medical coding?
- Are there levels of subjectivity in the coding process?
- How might organizational policies and resources, or the lack thereof, impact the coding process?
- How might human error impact the accuracy of medical coding?
- Describe key regulations that healthcare organizations must adhere to in order to ensure accurate medical coding, and describe the impact of these regulations on the coding process.
- Describe some common coding errors that may have contributed to the inaccuracies at Lower Mountain Hospital, as well as the reasons for these inaccuracies. Consider the following:
- Recommendations: Now that you have determined some common coding errors that may be impacting the coding at Lower Mountain Hospital, as well as regulations that the organization must adhere to, you will now provide the board with some process improvement recommendations.
- Recommend processes and practices Lower Mountain Hospital should follow to ensure accurate medical coding. Consider the following:
- How might the organization use technology to enhance the accuracy of its coding?
- How might the organization ensure that its coding team is using the most current coding conventions and all share the same understanding?
- What organizational policies might you recommend to ensure accurate coding and support continuity of care, as well as adhere to relevant guidelines and regulations?
- How can the organization ensure that it is prepared to address current and future trends related to reimbursement practices, quality-of-care initiatives, and data governance?
- Explain the importance of improving processes and ensuring accurate medical coding, as well as the repercussions of coding inaccuracies.
- Recommend processes and practices Lower Mountain Hospital should follow to ensure accurate medical coding. Consider the following:
What to Submit
Every project has a deliverable or deliverables, which are the files that must be submitted before your project can be assessed. For this project, you must submit the following:
Coding Process Improvement Report
Evaluate Lower Mountain Hospital’s coding processes, and recommend approaches for improving coding accuracy. Your report must be 500 to 1,000 words in length and cite any references.
