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Standards of ethical coding: why everyone should be aware of them: scenarios illustrate coding challenges that health care providers continue to face.

Article Excerpt
Since compliance concerns in health care first surfaced in the 1990s, providers, government entities, payers, and regulators have been grappling with the exact definitions of ethics. Nowhere is this more important than in the coding realm. When every claim contains ICD-9-CM, current procedural terminology (CPT), and/or HCPCS codes that represent procedures or services rendered, it may be difficult to impress upon coding and billing staff that each claim is basically an affidavit, attesting to the fact that the reported services were actually provided.

Some of the procedures and services provided in the health care setting are considerably more straightforward to code and bill than others. When services appear to be somewhat different than any of the available codes represent, or when certain services require additional information be reported, such as condition codes or additional modifiers, ethical considerations may arise. In an effort to assist providers in ensuring not only accurate payment but in developing ethical standards for all involved in coding and reporting, Standards of Ethical Coding were developed by the American Health Information Management Association (AHIMA) and approved by the cooperating parties, which include the following:

* AHIMA;

* American Hospital Association (AHA);

* Centers for Medicare & Medicaid Services (CMS, formerly HCFA); and

* National Center for Health Statistics (NCHS).

The Standards of Ethical Coding are as follows:

In this era of payment based on diagnostic and procedural coding, the professional ethics of health information coding professionals continue to be challenged. A conscientious goal for coding and maintaining a quality database is accurate clinical and statistical data. The following standards of ethical coding, developed by AHIMA's

* Coding Policy and Strategy Committee and approved by AHIMA's board of directors, are offered to guide coding professionals in this process:

* Coding professionals are expected to support the importance of accurate, complete, and consistent coding practices for the production of quality health care data.

* Coding professionals in all health care...

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