Summary:

Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance.

Responsibilities:

• Reviews encounters to assign and sequence appropriate diagnoses (including HCC Coding Hierarchical Condition Category) and CPT procedure codes as well as modifiers to complex diagnostic and surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.

• Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Create electronic physicians queries within allowed scope for hospital outpatient coder.

• Reviews all appropriate work queues daily to address edits and make corrections following Health Information Management (HIM) coding policies and procedures. Conducts, audits and/or coding reviews with various health care professionals to ensure all documentation is accurate for physician billing.

• Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews coding edits. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Research electronic medical record for any additional diagnoses documented to meet medical necessity. Codes various OP service lines for all MHS specialties that include encounters with high complexity of surgical procedures and assign anesthesia procedure codes (hospital) following specific payer requirements. Reads and interprets all provider documentation which includes all dictated, scanned, and electronically created documents, imaging, pathology reports, and labs pertaining to admission.

• Adjusts and adapts to continual changes in the coding field. Practices ethical coding per AHIMA Standards of Ethical Coding. Meets and maintains HIM coding quality and productivity standards. Submits daily productivity report to HIM manager by defined deadline.

• Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.

• Communicates with insurance companies about coding errors and disputes for physician billing. Reviews and validates accuracy of data in Admission-Discharge-Transfer (ADT) fields following HIM coding policies and procedures. Reviews CRW (Certified Social Worker) documentation to assign correct discharge disposition, notify coding management when clarification needed.

• Enhances and maintains coding knowledge and skills for physician billing. Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.

• For hospital encounters, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections when advised and follows procedure to notify billing. Reviews charge master generated CPT/HCPCS codes, when errors are found Coding Management is notified to alert Charge Management to educate department making errors. Makes appropriate coding corrections when advised and follows procedure to notify billing. For Professional Billing, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing.

Education and Certification Requirements: High School Diploma or Equivalent (Required) Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)

Required Work Experience: Two (2) years outpatient coding experience in a hospital setting

Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) is required