Sierra7
Medical Coder Outpatient (Finance)
Comply with all HIPAA provisions for a Business Associate.
Comply with all provisions in this Performance Work Statement.
Perform remote coding on all inpatient/ outpatient visits and surgical procedures by VA Health Care System (VAHCS).
Provide all labor, equipment and supplies for coding medical records from VAHCS.
Access VAs VistA/CPRS system to read and code medical records identified by VA and enters codes into the approved encoder or other package.
Perform the services following coding guidelines and appropriate references.
Create reports, monitor coders and make recommendations.
Code all cases no later than 7 days after receipt.
Priority cases that are assigned will be required to be coded within one day of receipt. Priority cases are normally assigned because of a backlog and are high dollar amounts or cases that need to be coded quickly.
Requirements
QUALIFICATIONS OF CODERS: GENERAL SPECIFICATIONS
Consultant is responsible for being qualified and competent to perform coding activities. There shall be no reimbursement charge for mileage, travel times, meals, parking, etc.The Consultant is responsible for making sure all contract coders are familiar with VA and VAHCS processes as they relate to coding.Consultant shall abide by the American Health Information Management Association established code of ethical principles as stated in the Standards of Ethical Coding, published by AHIMA.All consultants must complete the yearly privacy and security processes and training as required by the VAHCS.
Required Coder Knowledge and Skills
Comply with all VA privacy and security requirements.Coders will need to be able to code all types of coding to be able to transition between various types of coding to assist as needed. This includes outpatient, inpatient facility and professional, and surgical.Access and interpret health record documentation to identify all diagnoses and procedures that affect the current outpatient encounter visit, ancillary, inpatient professional fees and surgical episodes.Possess formal training in: anatomy and physiology, medical terminology, pathology and disease processed, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD, CPT, HCPCS, E&M, etc.).Apply GR, G8, QK, QX, QS, QY, and G9 modifiers correctly.Apply knowledge of current Diagnostic Coding and Reporting Guidelines for outpatient services.Apply knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly.Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT.Code in accordance with Correct Coding Initiative (CCI) Bundling Guidelines.Use the CMS Common Procedural Coding Systems (HCPCS), where appropriate.Exclude from coding information such as symptoms or signs characteristic of the diagnoses, unless guidance is given to code also, findings from diagnostic studies or localized conditions that have no bearing on current management of the patient.Clarify conflicting, ambiguous or nonspecific information appearing in the record by consulting with the contract coder supervisor who shall, if necessary, discuss with VAHCS designated contact.Be able to code inpatient discharges when requested by VHA; e.g., quarterly census, etc.Utilize all appropriate resources to ensure correct code assignmentsIdentify whether an episode is billable the reason not billable (RNB) shall include, at a minimum, treatment for a Service Connected (SC) condition, treatment related to Agent Orange (AO) exposure or Ionizing Radiation (IA), lack of attending documentation in a circumstance that requires it, telephone care, non-billable provider, or other types of care that cannot be billed.
Required Coder Education and Experience
Coders must be credentialed and have completed an accredited program for coding certification, an accredited health information management or health information technician. A certified coder is someone credentialed by the: American Health Information Management Association (AHIMA) and includes RHIA, RHIT, CCS and CCS-P,orAmerican Academy of Professional Coders (AAPC) as a CPC or CPC-HCredentialed Coders must have a minimum of two years experience in inpatient and outpatient coding.
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Surgical Coding:
Code surgical reports and associated anesthesia reports using CPT, HCPCS, and ICD diagnoses. All surgical procedures, anesthesia codes and adjunct procedures for anesthesia shall be entered into the approved VA encoder or other package. All surgical narrative and codes will be entered into the VA encoder surgical package. Anesthesia and pathology have separate encounters to enter all required data, providers, diagnoses, and CPT codes).Review the documentation and data in the Surgical Package to ensure surgical cases all meet Resident Supervision guidelines. This data is captured as a data element in the VistA Surgical Package, although it may not appear on the actual operation report.Create encounters for Professional Fee Clinics only when there is no encounter present for data entry to ensure proper workload credit for all service lines. The coder shall enter provider names, diagnoses, CPT and HCPCS codes, along with any appropriate modifiers, additional entry of associated diagnoses, and provider for every CPT/HCPCS assignment.Use required modifier 26 for Pathology, Radiology, or other diagnostic tests.
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ER and Inpatient Professional Services Provided by Non-VA Providers
Consultant shall use CPT and ICD for coding emergency room services and inpatient professional services delivered by non-VA providers.
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Inpatient Facility coding
Inpatient facility coding is to be completed within seven (7) calendar days from the date coding is assigned.Per VHA Directive 2011-025, all Patient Treatment File data must be accepted by the Austin Information Technology Center and/or Veterans Health Administration Corporatedata Warehouse no later than seven (7) calendar days from the data of patient discharge. The only exceptions are Patient Treatment File discharges from Contract or Community Nursing Home and non-Department of Veterans Affairs Purchased Care patient files. Error corrections must be re-transmitted by the closeout deadline.Inpatient facility coding is performed on all inpatient episodes of care, to include Observation and non- Veterans Affairs care under Veterans Affairs auspices, regardless of billable status. Applicable coding guidelines will be followed.All inpatient facility coding will be entered into the Patient Treatment File utilizing the encoder software.The Veterans Health Administration Handbook 1907.04 establishes procedures and covers the responsibilities and requirements for the appropriate use of the Patient Treatment File and provides specific instructions for completing each Patient Treatment File transaction (e.g., admission transaction (101), Patient Movement Transaction (501), Surgical Transaction (401), etc.).A Present on Admission field entry is required for patients that are admitted to certain levels of care. The Present on Admission field is not required for Community Living Center and Domiciliary patients. The Present on Admission provides information on whether a diagnosis was present at the time of a patient's admission. The indicator is required to be assigned to all diagnosis codes involving inpatient admission. Each diagnosis, principal and secondary, and external causes of injury are required to have a Present on Admission indicator appended.Non- Veterans Affairs purchased care Patient Treatment File coding utilizes the non-Veterans Affairs invoice, as well as submitted clinical documentation if received.