Purpose Statement / Position Summary For the purposes of complete accurate code assignment, reimbursement, reporting and research, follows established MHS coding guidelines, Federal & State coding rules and regulations, and all Federal & State reporting requirements. Codes all payer types of outpatient surgery medical records (including other outpatient type accounts) using appropriate classification systems. Abstracts designated demographic and clinical data for profiling and benchmarking. Ensures correct code assignment, modifier use and sequencing to provide for maximum achievable accuracy & completeness of clinical documentation and allowable hospital reimbursement under the Federal Government's Perspective Payment System for ambulatory surgery, as well as ensuring appropriate scoring for benchmarking and quality reporting to CMS (Centers for Medicare and Medicaid Services), TJC (The Joint Commission), OSHPD (Office of Statewide Health Planning and Development), and other benchmarking agencies.
Essential Job Outcomes & Functions
Reviews medical records of all outpatient surgery (including other non-ancillary outpatient accounts) payer types to determine the principal diagnosis and procedure.
Utilizes query forms to consult with physician when documentation clarification is necessary
Following all regulatory guidelines, utilizes technical coding principals and APC reimbursement expertise to assign appropriate ICD-9/10 PCS diagnoses and ICD-9/10 CPT procedures
Using the International Classification of Diseases (ICD9/10) and the Current Procedural Terminology (CPT) coding classification systems, assigns codes to all diagnoses and procedures following applicable coding principals and department guidelines; enters into the computer coding system
Abstracts and codes all required clinical and demographic data for reporting to CMS (Centers for Medicare and Medicaid Services), OSHPD (Office of Statewide Health Planning and Development), Quality Management, and Medical Staff; enters information into the computer abstracting system
Maintains current knowledge of the most recent ICD-9-CM/ICD-10 CM/PCS Official Guidelines for Coding and Reporting, the annual changes to the ICD9/10 diagnosis and procedure codes, the annual changes to the inpatient perspective payment system, CPT procedure codes, as well as the quarterly changes to the APC reimbursement system, and the annual changes to the reporting and reimbursement system
Demonstrates the ability to accurately and timely code all medical records, including Medicare, to expedite hospital reimbursement, clinical pertinence and indices
Demonstrates the ability to take job ownership by offering suggestions and showing a commitment to job completion
Minimum Requirements / Work Experience
3 years ICD-9/10coding and APC reimbursement experience in an acute care hospital
Expert knowledge of MS-DRG methodology
Experience with 3M APR-DRG software
Expert knowledge of Severity of Illness and Risk of Mortality methodology