MEDICAL CODING PROBLEM

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MEDICAL CODING PROBLEM


Cheryl2 02-10-2010, 8:12 AM
I have to work on software for people who code inpatient visits for a hospital. I need to find out what is happening in the real world. For each inpatient visit that is discharged, it checks to see if either of the following two conditions, A and B, is true. Each condition, if true, produces something that needs to be coded. What is happening?

A. If the operative notes, cardio and pathology reports are done, then create a document to be coded.

B. If the balance is less than or equal to zero, then create a document to be coded.

1. What are these documents being created? What are they used for?

2. Furthermore, there are two types of coders: onsite and offsite. One type codes the documents produced by (A) and the other type codes the documents produced by (B). Is there a reason that people who are onsite or offsite would code that particular kind of document, (A) or (B)?

3. They say there is a problem in that a discharge can have both documents and two different coders get the documents. Is that a rule, that it is better if the same person codes both of these documents when they both exist on one discharge?

Thanks for any answers or explanations.

Re: MEDICAL CODING PROBLEM


Barb S. 02-18-2010, 4:13 PM

There are Federal and State laws tthat apply to billing for medical services. In order to bill an insurance carrier on a patient's behalf and/or bill a patient you not only are required to code the services...you are required to keep and have available documentation in support of those services. Operative notes, cardio and pathology reports, etc. are the types of documentation that needs to be kept. Hospitals and providers are reimbursed for their services based on the levels of service provided. The documentation supports the level of services provided by a hospital or a provider (doctors, therapists, nurse practicioners, etc.) to the patient.

 CPT (procdure codes) and ICD-9-CM (diagnosis codes) are used by both hospital based and physician based coders, they are applied differently. Medicare has Part A and Part B coverage for services. Part A is for hospital based service and Part B for the provider (physician, non-physician provider) services. Each has it's own rules, regulations, and guidlines on how services and procedures are to be billed and how they get reimbursed.

Simply:   Onsite coders are probably the hospital based coders...coding for the services provided by the hospital and it's staff.  Offsite coders are probably the ones coding the physician's or other provider's services.  It's more complicated than that, but would take a lot more space to explain fully.

At discharge, a patient who was an inpatient will get billed for services provided by the hospital and it's staff. This includes facility charges for use of equipment owned by the hospital, the rooms, operating suites, etc. as well as staff services. A physician who sees a patient at the hospital, perhaps does surgery or another service for the patient would bill his or her services separately from that of the hospital. Due to the different rules and regulations regarding hospital based vs physician based services, the different coders would each need documentation to code for whoemever they represent.

If the patient is a Medicare patient, the bills for the hospital would go to Part A Medicare, while the physcian/provider's charges for services performed would go the Part B Medicare.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Re: MEDICAL CODING PROBLEM


Cheryl2 02-24-2010, 8:50 PM
Thanks. And,

1. What specifically are the coders doing under condition A and under condition B?

2. Why are these two conditions, A and B, imposed the way they are - what does it mean for those conditions to be true - why must they be true?

Re: MEDICAL CODING PROBLEM


Barb S. 02-25-2010, 8:23 AM

Can you talk directly with one of the coders from the group you are doing the software for?

I'm guessing as to what you are looking for...not enough information on exactly what the A and B you're speaking of is. I am thinking they are referring to Medicare Part A aand Medicare Part B. Medicare Part A governs the billing of hospital charges, while part B governs the physician charges. Each has it's own rules and regulations that have to be followed. While basically the codes are the same...the regulations covering their billing differ from Part A  to those of Part B. Part A is hospital based billing. Part B is physician based billing.

However, the group you're coding for may have a different "internal"/"specific to their office" meaning for A and/or B.

 

Re: MEDICAL CODING PROBLEM


manishfusion 02-26-2010, 9:58 PM
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