nursing coding guidelines

nursing coding guidelines

The coding guidelines play a significant role in meeting the transparency, accuracy, precise and reliable data demands in the nursing sector. Why are coding guidelines used? Coders largely depend on the coding guidelines to make accurate and trustworthy codes. Published and Maintained by the American Medical Association (AMA), the coders are obliged to use the coding guidelines to attain full sight of the encrypted data as they relate to the current and future use in the medical sector (AHIMA, 2015). For example, when reporting the diagnosis and procedural codes of a surgical procedure, the coders provide definitions, rules, and track processes to ensure accurate care procedures.

Existing in multiple types, the coding guidelines get used in establishing many medical procedures. The medical practitioners apply the rules and procedures set by the codes in undertaking their medical roles. These codes cover all the instances that are the probable, questionable, suspected and the still to be ruled out conditions (AHIMA, 2015). For example, using the coding guidelines, the coders, and the medical practitioners can ascertain the treatment procedure to handling the Ebola cases abiding b the set rules. The coding guidelines are critical to the successfulness of a coder as they set a blueprint of what is needed to be done to make up the right codes (Belby, 2016). Here, a successful coder gets determined by the success of their laws in coming up with procedural directives keeping in mind the guidelines set.

Complying with the AMA rules, the coding guidelines present immense significance in the coding process and medical practices at large. Coding guidelines allow the coders to code to the highest level of specificity that is being clear of the patient’s condition, symptoms and diagnosis allowing specificity to the right codes, ruling out the probable instances (Belby, 2016). The coding guidelines also provide a coding range for all chronic conditions and populations allowing availability of the right procedures to counter the devastating conditions, evidence-based care (Alan Pearson, 2012). The coding process strives to ensure transparency in the medical procedures which has seen a significant evolution in the process adopting new ethical methods to improve the coding guidelines. For example through the provision of coding resources such as the ICD-10-CM, ICD-10-PCS, MS-DRG, Workbooks and WebLinks, AMA has been able to improve the coding process over time (Karla & Schwersfeger, 2014).

References

AHIMA. (2015, October 12). AHIMA Standards of Ethical Coding. Retrieved from AHIMA: bok.ahima.org/doc?oid=106344#.V7k-qjNjTl0

Alan Pearson, J. F. (2012). Evidence-Based Clinical Practice in Nursing and Health Care: Assimilating. New York: John Willey and Sons.

Belby, J. A. (2016). Coding with integrity: Top Coding Tips from AHIMA experts. Retrieved from AHIMA: bok.ahima.org/doc?oid=106660#.V7k-qDNjTl0

Karla, R., & Schwersfeger, J. (2014). Evolve Resources for ICD-10-CM/PCS Coding: Theory and Practice. Edinburgh: Elsevier.