Clinical indicators coding guideline sparks mixed reactions from healthcare professionals

As coders grow and mature in their knowledge and experience with ICD-10, there are various federal guidelines they must adhere to. One such guideline instructing coders not to use clinical indicators for code assignment is prompting considerable interest from healthcare providers, according to ICD-10 Monitor.

The report's author, Sandra L. Brewton, a senior healthcare consultant for Panacea Healthcare Solutions, said she has received emails from colleagues and physicians, expressing concerns or sharing enthusiasm for coding and documentation integrity.

She said the guideline comes as the use of clinical indicators has the potential to be abused by papers and hospitals. "On the payer side, the absence of clinical indicators has been used to their advantage, and as a basis to require facilities to return money. On the hospital side, some facilities are using clinical indicator coding as a form of offense against those payer audits. It's your standard cat-and-mouse game," Ms. Brewton writes.

And one physician, Ronald Hirsch, MD, a physician advisor, told Ms. Brewton: "I wish I could share your enthusiasm for the integrity and accuracy of physician documentation. As a physician, I can attest that it is very common for doctors to document things that do not exist. I think the origin was with the need for appropriate diagnoses to get tests authorized."

"It's a tough situation," Dr. Hirsch said, "but I absolutely agree that coders should not be the ones clinically validating diagnoses."

Regardless of a person's opinion of the guideline, it may assist in the defense of coding and documentation, according to Ms. Brewton.


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