What We’re Reading – Sometimes physician query is imperative

A staff member’s role is one of supporting the clinician.  However, in the area of coding and billing, the perspective is more of collaboration as the employee must appropriately transfer the practitioner’s documentation into correct codes, advise him/her on the coding guidelines, and solicit clarification when information is ambiguous.  After all, certain documented information can be misinterpreted, be confusing or in some cases, be incorrect, and these will affect reimbursement; consequently, proper querying of the physician is critical to accurate reimbursement, especially in the realm of inpatient care when the medical necessity of an admission can be called into question. In addition to affecting reimbursement, this can impact the authorization process by the patient’s insurer. For example, the word ‘acute’ is often misused. This article’s author defines the concept of acute as ‘something has changed in an otherwise stable condition.’  Diagnoses such as pericarditis and appendicitis may imply their acute status, but this does not preclude the need to document correctly.

This article covers several other language issues in greater detail and highlights the need to query the physician in order to select the most correct and specific codes for the encounter.  Using proper codes also affects the integrity of the data which is used worldwide in tackling health concerns and establishing policy.

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