Ethics in Medical Coding: Theory and Practice

Overview

Main description

Ethics in Medical Coding: Theory and Practice addresses the challenging topics of ethics and compliance in medical coding, billing, and health information management. From choosing a diagnosis or procedure code to navigating payer requirements and installing an EHR system, this text's down-to-earth style explains potential ethical dilemmas and offers practical methods for solving them. Case studies and exercises throughout each chapter provide opportunities to go beyond the theory. Chapters on compliance programs, health care reform, EHR, and ICD-10 ensure that you'll be prepared to navigate the ethical challenges ahead.

Table of contents

ETHICS IN MEDICAL CODING: THEORY AND PRACTICEChapter 1: Defining Coding: The Accurate Reporting of Medical Services1.1 The Definition of Medical Coding1.2 The Coder’s Tools1.3 Methods of Reporting Codes1.4 The Fundamentals of CodingPART 1: THE FUNDAMENTALS OF ETHICSChapter 2: Ethics and the Importance of Ethical Systems2.1 Definitions and Views of “Ethics”2.2 Methods of Determining Ethical Norms2.3 The Importance of Ethics for Individuals, Business, and Society2.4 Factors That Influence Business Ethics2.5 The Relationship Between Law and Ethics2.6 The Range of Ethical Approaches to Individual and Corporate Behavior2.7 The Ethics System That Best Serves Billing and CodingChapter 3: Why Ethical Dilemmas Occur3.1 Defining Ethical Dilemma3.2 The Reasons Why People Behave Unethically3.3 The Roots of Unethical Behavior in Business3.4 Why Unethical Behavior Continues to Occur3.5 Practical Tools for Analyzing and Resolving Ethical Dilemmas3.6 Case Studies of Ethical Dilemmas in Billing and CodingPART 2: ETHICS IN CODINGChapter 4: Coding, Ethics, and Third-Party Financing4.1 The Unique Elements of the U.S. Health Care Payment System4.2 The Stakeholders in Business Transactions and the Medical Coding Process4.3 Evaluate the Role Played by Each Stakeholder in the Medical Coding Process4.4 Thoughts and Behaviors of Stakeholders in Healthcare Chapter 5: Evaluation and Management Services5.1 Factors to Consider in Selecting an E/M Code5.2 Elements of History Documentation and the Occurrence of Ethical Problems in Relationship to History5.3 Examination Documentation Guidelines and the Opportunity for Ethical Problems5.4 The Role of Medial Decision Making in Code Assignment and Ethical Problems5.5 Time as the Determining Factor in E/M Code Selection5.6 Common Opportunities for Ethical Dilemmas in Billing and Coding for E/M Services5.7 Summarizing the E/M Coding Process Chapter 6: Surgical and Procedural Services6.1 Services Included in the Global Surgical Package6.2 Bundling and Unbundling6.3 The Use of Modifiers and Ethical Procedural Coding6.4 Ethical Choices Regarding Procedure Methods and Unlisted Codes6.5 Separate Billing of Supplies and Procedures Chapter 7: Diagnosis Codes7.1 The Basics of Diagnosis Coding7.2 Guidelines for ICD-9-CM Coding and Reporting7.3 Ethical Issues: Intentional Misuse of Diagnosis Codes7.4 Ethical Dilemmas: Omitting or Misleading Information7.5 Analyzing Ethically Challenging Situations Chapter 8: Coding Ethics and ICD-108.1 The ICD-10-CM Code Set and the Transition from ICD-9-CM8.2 Similarities and Differences Between ICD-9 and ICD-10 and Tools for Transition8.3 The Ethical Challenges of ICD-10-CM8.4 Addressing and Avoiding Ethical Challenges Associated with ICD-10 Chapter 9: Coding Ethics and the Revenue Cycle9.1 Stages of the Medical Revenue Cycle9.2 Ethical Issues in Registering Patients and Assigning Financial Responsibility9.3 Ethics and Patient Activity in the Facility or Clinic9.4 Code Assignment, Ethics, and the Revenue Cycle9.5 Ethical Issues in Relation to Third-Party Payers9.6 Ethical Issues in Patient Statements and Collections Chapter 10: Coding Ethics and Certification Entities10.1 The Benefits of Employing Certified Coders10.2 The Importance of Professional Certification for the Coder10.3 Major Coding Certification Entities10.4 The Certification Process10.5 Certification Entity Codes of EthicsChapter 11: New Issues in Coding Ethics11.1 The Health Care Environment: Electronic Health Records11.2 Ethical Issues Associated with Selection and Installation of Electronic Health Records11.3 Ethical Problems Associated with EHR Use11.4 Health Care Reform and Coding Ethics11.5 Mandatory Compliance Programs and the Patient Protection and Affordable Care Act PART 3: APPLYING ETHICAL PRINCIPLESChapter 12: Avoiding Ethical Problems12.1 Strategies for Avoiding Ethical Problems in Medical Billing and Coding 12.2 Implementing Effective Corporate Ethics Policies 12.3 Avoiding Ethical Dilemmas by Developing Business Department Protocols 12.4 Constructing Strategies for Communicating with Patients to Avoid Ethical Problems Chapter 13: Resolving Ethical Problems When They Occur13.1 Options Available to Those Facing Ethical Dilemmas Caused by Their Employer13.2 Methods That Employees Can Use When Ethical Dilemmas Occur 13.3 Practical Tips and Resources for Dealing with Ethical Problems in Medical Billing and Coding13.4 The Value of Adhering to Ethical Principles