Assignment: The role of clinical coding

For this assignment of your Compliance Process , include a discussion of the role of clinical coding as it relates to compliance and indicate which of the seven elements applies to what you have learned in this module.

You should reference at least one new research source (Wikipedia, your textbook, and the source you used previously are not acceptable research sources) in your paper, and you must include appropriate citations for those sources.

Requirements

Discusses the role of clinical coding as it relates to compliance.

Indicates which of the seven elements applies to what you have learned in the module.

Provides appropriate citations for at least 1 research source.

Article: The barriers to clinical coding in general practice: A literature review by S. DE LUSIGNAN.

NCCI Edits

Clinical Coding and the National Correct Coding Initiative

National Correct Coding Initiative

The CMS developed the National Correct Coding Initiative (NCCI) to elevate correct coding on a national level and to control improper coding leading to inappropriate payment on Part B claims. The edits are based on coding conventions defined in the American Medical Association's CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The Coding Policy Manual (National Correct Coding Initiative Coding Policy Manual for Medicare Services) is updated annually. The Coding Policy Manual should be used by carriers and others submitting claims as a reference tool to expound the rationale for NCCI edits.

NCCI edits were implemented for dates of service after January 1, 1996. The NCCI edits contain two tablets of edits. The Column One/Column Two Correct Coding Edits table and the Mutually Exclusive Edits table include code pairs that should not be reported together for a number of reasons explained in the Coding Policy Manual.

The policies in the manual refer to "physician," but that does not necessarily mean the physicians are the only ones responsible for complying with the policies. It applies to all practitioners, hospitals, providers, or suppliers eligible to bill the relevant HCPCS/CPT codes pursuant to applicable portions of the Social Security Act (SSA) of 1965, the Code of Federal Regulations (CFR), and Medicare rules.

The Column One/Column Two Correct Coding Edits table

Often the column two code is a component of a comprehensive column one code, but this relationship is not true for many edits. However, when it is true, the appropriate modifiers should be added to the codes to clear the edit. One example would be reporting a partial vaginal hysterectomy and a total abdominal hysterectomy together.

Clinical Coding

Standardized coding systems allow for an efficient payment process. Code sets remain constant regardless of the healthcare setting. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) designated the code sets used for reporting to public and private health insurers. For physicians, the code set designated is International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) and Current Procedural Terminology (CPT). For hospitals, the code sets designated are ICD-9-CM and Healthcare Common Procedure Coding System (HCPCS), which includes CPT and HCPCS Level II.