How do you create a Coding Policy and Procedure?

To write a Coding Policy and Procedure to aid your organization in complying with applicable regulations.

Interpret the payment system(s) that apply to this type of facility and ensure the coding and collection of all the data elements required for billing under that system.

o The payment system grids you completed for homework will be a helpful reference.

Determine the individuals or groups responsible for applying codes to patient encounters (coder, physician, nurse, laboratory technician, tec.) and which types of codes they would apply (ICD-10-CM, CPT, etc.).

Recommend methods for ensuring correct reimbursement (preventing and monitoring for fraud and abuse).

I am not expected to know how to apply specific ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II codes to write this policy and procedure. don't worry about that.

Scenario

Anytown Hospital

Anytown Hospital is a growing organization. The hospital has expanded outpatient services, increasing the workload and the complexity of work in the HIM department. It is now time to update the department policies and procedures to reflect the new services at Anytown Hospital. You will begin with the Coding Policy and Procedure and you will need to include coding considerations for: Hospital Inpatient Services

Hospital Observation Services

Emergency Department Services

Outpatient Surgery (Ambulatory Surgery but not a free-standing Ambulatory Surgery Center)

Outpatient Therapy Services including Physical Therapy, Occupational Therapy, and Speech Therapy

Outpatient Diagnostic Services including Diagnostic Imaging (Radiology) and Laboratory

Hospital-owned Physician Practices (General Surgery, Orthopedic Surgery, and Primary Care)

Hospital-owned Skilled Nursing Facility