The Second Standard Of Ethical Coding

In this paper I’m going to talking about what AHIMA (American Health Information Management Association) and APPC(American Academy of Professional Coders) code of ethics are and the relevance that these two have to the coding profession. Then I’m going to explain how AHIMA and APPC code of ethics are incorporated into the Medical Insurance Specialist (MIS) field, and why continuing your education is important in this field. Hopefully after reading this paper you will have learned the difference between AHIMA and APPC codes of ethics.

6. Why did the Centers for Medicare and Medicaid Services (CMS) implement the National Correct Coding Initiative in 1996?

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

For all of the professional bodies that are related to the health and social care profession would have the code of practices and for any researchers that are in the health and social care would be have to obey with the codes of code of practice as it expected when it comes to their professional body. For everyone that works in any relation with the NHS, then they must comply with the NHS NPSA which stands for the National Patient Safety Agency guidelines that are for the Research Ethnic Committee review.

Coding systems are used in the inpatient and outpatient settings for the classification of patient morbidity and mortality information for statistical use. The World Health Organization (WHO) developed the Ninth Revision, International Classification of Diseases (ICD-9) in the 1970s to track mortality statistics across the world. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), is the adaptation the U.S. health system uses as a standard list of six-character alphanumeric codes to describe diagnoses. Globally utilizing a standardized system improves consistency in recording symptoms and diagnoses for payer claims reimbursement, as well as clinical research, and tracking purposes.

As mentioned in my discussion, Health Information Coding Supervisors are trusted individuals who have access to an organization’s highly confidential security system. A misrepresentation of this position can lead to significant consequences because of the Health Insurance Portability and Accountability Act (Prophet, 2015). Criminal penalties imposed on individuals who knowingly and willfully attempt to execute a scheme to defraud any health care benefit program can be up to 10 years imprisonment and possibly life imprisonment depending on the circumstances. Civil monetary penalties can lead to $2000 to $10,000 for each fraudulent payment received.

Uninformative codes can create confusion to what the code details. This language needs to be clear and detailed so that the health care organizations can provide the best health care as possible. When codes are

An accurate and specific documentation of universally accepted set of codes are important for the protection of healthcare providers as well as increased reimbursement for services received. These codes are for the validation of which services the patient received from their health care provider ( (Page, 2009). Having the correct codes in place insures the provider with the information needed by the health insurance carrier. Maintained by the AMA (American Medical Association), this universal numeric assignment is also used for developing guidelines for medical care review as well as data collection for medical education and research (Scott, 2013).

The majority of the time the use of HIM coders are involved in billing and reimbursements. However, coding specialists are important players within the healthcare industry.(Davis, 2014,2007,2002) They certify that providers maintain accuracy with coding procedures and government rules. (Davis, 2014,2007,2002) HIM functions and complex of regulatory requirements where coding can be very challenging. (AHIMA, 2016) The coders follow guidelines of the American Health Information Management Association AHIMA) Code of Ethics. (AHIMA, 2016) On the patient level, it is vitally important for the coder to code accurately because this information will trail the patient success throughout their course of treatment and beyond.

I agree that certain situations can determine the differences between right and wrong and what one believes. I also agree that the ANA code ethics is a good foundation in practicing nursing and that every nurse should use them as a guideline when practicing. I work in a recovery room where HIPPA goes right out the window. It is a big open room, and everybody can see everybody. I have patients talk to one another while they wait to go to the next phase and discuss their surgeries. I have had patients ask me what surgery their neighbor had and family members who walk throughout the unit. Those are easy to deal with and usually do not cause much turmoil. The more pressing cases are patients who present with the ethical dilemma of what is right

In my request for written documentation due to management advisement not to query, I would include the AHIMA Standards of Ethical Coding, highlighting lines 4, 6, 9 and 11. I would also express my concern that this could possibly cause me to lose my credentials. Consequently, if a manager refused to provide me written direction

1. Differentiate between the official coding guidelines for using V codes in an inpatient and outpatient setting.

There is an accentuation on the need for quality of coded data with the use of computer-assisted coding in healthcare organizations to assure compliance is being met with regards to the increasingly multifaceted quality reporting requirements.

What this means to me is as healthcare professional workers is we must follow the guidelines completely and accurately. It is very important to submit the right information being accurate so it doesn’t effect the reimbursement, public data reporting, quality and patient safety measurement, and research. Its very important that HIM professionals pay attention to details. “Coding professionals, regardless of their professional function or setting in which they work, should remember to first code to only what is supported by documentation in the chart and second ask for clarification if documentation is unclear.” (AHIMA) We are to remain professional when we code following and the procedures and guidelines and not make up our owns rules.

"Our results indicate that the informal methods ("manager sets an example" or "social norms of the organization") are likely to yield greater commitment with respect to both employee attitudes than formal methods ("training courses on the subject of ethics") (Adam, et al, 2004).