Coding Resources Available in 3M Software
Coding Resources Available in 3M Software
As a medical coder, having all the right tools is necessary to do the job. There are many rules and regulations when it comes to coding, and two vital tools that coders have at their disposal are the (AHA) Coding Clinic and the (AMA) CPT Assistant. These are located within the 3M Coding Software and assist coders in effectively performing their jobs while helping to prevent fraud and abuse. The purpose of this research paper is to provide more insight as to what the (AHA) Coding Clinic and (AMA) CPT Assistant are, and to get a better look at how both resources help to prevent fraud and abuse.
The AHA Coding Clinic and AMA CPT Assistant
The (AHA) Coding Clinic for ICD-10-CM and ICD-10-PCS is a quarterly newsletter which is published by the American Hospital Association (AHA), American Health Information Management Association (AHIMA), the Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) (AHA Central Office). This tool delivers the most recent coding information to medical coders, auditors, government agencies and third-party payers to improve upon the accuracy of medical coding.
The (AMA) CPT Assistant is a monthly publication from the American Medical Association (AMA) that provides information and clarification regarding proper CPT code usage (Gawenda, Rick). This vital tool has many uses including coding validation regarding auditors, overturning denials, provider, payer and coder education, answering some of the most frequently asked questions, and improving compliance.
AHA Coding Clinic and AMA CPT Assistant to Prevent Fraud and Abuse
Medicare defines fraud as “an intentional representation that an individual knows to be false or does not believe to be true and makes, knowing that the representation could result in some unauthorized benefit to himself/herself or some other person” (Castro, Anne B.). Abuse results when a provider, either unknowingly or unintentionally, submits an inaccurate claim for payment. The (AHA) Coding Clinic and the (AMA) CPT Assistant both help to prevent fraud and abuse. Both resources are updated with the most current information to help prevent such errors. With access to both the Coding Clinic and the CPT Assistant, medical professionals have a wealth of information that they can reference if they are ever unsure about something. As healthcare professionals, making assumptions is outside the realm of acceptability, so having this information at our fingertips provides a closed door to excuses.
An Article That Would Benefit a Coder
Within the (AHA) Coding Clinic, I found an article regarding the use of non-provider documentation for external cause of morbidity (Coding Clinic). The article states that when coding external causes of morbidity, the use of up to four codes may be required to properly and completely code the incident. The question here was whether coders can use non-provider documentation if a physician does not document certain information. Non-provider documentation includes nurse’s notes, ambulatory notes, etc.
The conclusion of this article is that coders should always use information contained within the official medical record. Regarding external causes of morbidity, the codes are assigned based on physician documentation, but if the physician does not document certain information that is needed to obtain all the codes necessary, coders are in fact allowed to use non-provider documentation. The only time this differs is if there is a conflict between the physician and non-physician documentation, in which case the documentation provided by the physician takes precedence. I believe this article would be beneficial to a coder because external causes of morbidity can be difficult to code sometimes, and most often, there is a lot of information that a coder needs to review. To save time, it is helpful to know that non-physician documentation can be used to assign codes.
Final Comments and Conclusions
In conclusion, the medical field is a vastly ever-changing expanse that requires the employment of morals, ethics, and compliance. The information that coders and health professionals handle each day is extremely sensitive, and it should be noted that the rules and regulations that are set in place are there for good reason. With resources such as the (AHA) Coding Clinic and the (AMA) CPT Assistant, we can navigate the waters of coding compliance more easily while gaining a better understanding of the medical aspects of the field of health information management.
ICD-10-CM/PCS Coding Clinic. (First Quarter, 2014). Use of Nonprovider Documentation for External Causes of Morbidity. Retrieved from http://3m.ahima.org:8080/3mhis/wcrs/reference2/index.html?file=cc.ref;RepId=1 .
Casto, Anne B. (2015) Principles of Healthcare Reimbursement, Fifth Edition. Chicago, Illinois: AHIMA.
Gawenda, Rick. (2016, May 12). What is CPT Assistant? Retrieved from https://gawendaseminars.com/2016/current-news-posts/what-is-cpt-assistant/ .
AHA Central Office. (Referenced on September 14, 2018). What is Coding Clinic for ICD-10-CM and ICD-10-PCS? Retrieved from http://www.ahacentraloffice.org/aboutus/what-is-icd-10.shtml .