ETHICS IN MEDICAL CODING: THEORY AND PRACTICE

Chapter 1: Defining Coding: The Accurate Reporting of Medical Services

1.1 The Definition of Medical Coding

1.2 The Coder’s Tools

1.3 Methods of Reporting Codes

1.4 The Fundamentals of Coding

PART 1: THE FUNDAMENTALS OF ETHICS

Chapter 2: Ethics and the Importance of Ethical Systems

2.1 Definitions and Views of “Ethics”

2.2 Methods of Determining Ethical Norms

2.3 The Importance of Ethics for Individuals, Business, and Society

2.4 Factors That Influence Business Ethics

2.5 The Relationship Between Law and Ethics

2.6 The Range of Ethical Approaches to Individual and Corporate Behavior

2.7 The Ethics System That Best Serves Billing and Coding

Chapter 3: Why Ethical Dilemmas Occur

3.1 Defining Ethical Dilemma

3.2 The Reasons Why People Behave Unethically

3.3 The Roots of Unethical Behavior in Business

3.4 Why Unethical Behavior Continues to Occur

3.5 Practical Tools for Analyzing and Resolving Ethical Dilemmas

3.6 Case Studies of Ethical Dilemmas in Billing and Coding

PART 2: ETHICS IN CODING

Chapter 4: Coding, Ethics, and Third-Party Financing

4.1 The Unique Elements of the U.S. Health Care Payment System

4.2 The Stakeholders in Business Transactions and the Medical Coding Process

4.3 Evaluate the Role Played by Each Stakeholder in the Medical Coding Process

4.4 Thoughts and Behaviors of Stakeholders in Healthcare

Chapter 5: Evaluation and Management Services

5.1 Factors to Consider in Selecting an E/M Code

5.2 Elements of History Documentation and the Occurrence of Ethical Problems in Relationship to History

5.3 Examination Documentation Guidelines and the Opportunity for Ethical Problems

5.4 The Role of Medial Decision Making in Code Assignment and Ethical Problems

5.5 Time as the Determining Factor in E/M Code Selection

5.6 Common Opportunities for Ethical Dilemmas in Billing and Coding for E/M Services

5.7 Summarizing the E/M Coding Process

Chapter 6: Surgical and Procedural Services

6.1 Services Included in the Global Surgical Package

6.2 Bundling and Unbundling

6.3 The Use of Modifiers and Ethical Procedural Coding

6.4 Ethical Choices Regarding Procedure Methods and Unlisted Codes

6.5 Separate Billing of Supplies and Procedures

Chapter 7: Diagnosis Codes

7.1 The Basics of Diagnosis Coding

7.2 Guidelines for ICD-9-CM Coding and Reporting

7.3 Ethical Issues: Intentional Misuse of Diagnosis Codes

7.4 Ethical Dilemmas: Omitting or Misleading Information

7.5 Analyzing Ethically Challenging Situations

Chapter 8: Coding Ethics and ICD-10

8.1 The ICD-10-CM Code Set and the Transition from ICD-9-CM

8.2 Similarities and Differences Between ICD-9 and ICD-10 and Tools for Transition

8.3 The Ethical Challenges of ICD-10-CM

8.4 Addressing and Avoiding Ethical Challenges Associated with ICD-10

Chapter 9: Coding Ethics and the Revenue Cycle

9.1 Stages of the Medical Revenue Cycle

9.2 Ethical Issues in Registering Patients and Assigning Financial Responsibility

9.3 Ethics and Patient Activity in the Facility or Clinic

9.4 Code Assignment, Ethics, and the Revenue Cycle

9.5 Ethical Issues in Relation to Third-Party Payers

9.6 Ethical Issues in Patient Statements and Collections

Chapter 10: Coding Ethics and Certification Entities

10.1 The Benefits of Employing Certified Coders

10.2 The Importance of Professional Certification for the Coder

10.3 Major Coding Certification Entities

10.4 The Certification Process

10.5 Certification Entity Codes of Ethics

Chapter 11: New Issues in Coding Ethics

11.1 The Health Care Environment: Electronic Health Records

11.2 Ethical Issues Associated with Selection and Installation of Electronic Health Records

11.3 Ethical Problems Associated with EHR Use

11.4 Health Care Reform and Coding Ethics

11.5 Mandatory Compliance Programs and the Patient Protection and Affordable Care Act

PART 3: APPLYING ETHICAL PRINCIPLES

Chapter 12: Avoiding Ethical Problems

12.1 Strategies for Avoiding Ethical Problems in Medical Billing and Coding

12.2 Implementing Effective Corporate Ethics Policies

12.3 Avoiding Ethical Dilemmas by Developing Business Department Protocols

12.4 Constructing Strategies for Communicating with Patients to Avoid Ethical Problems

Chapter 13: Resolving Ethical Problems When They Occur

13.1 Options Available to Those Facing Ethical Dilemmas Caused by Their Employer

13.2 Methods That Employees Can Use When Ethical Dilemmas Occur

13.3 Practical Tips and Resources for Dealing with Ethical Problems in Medical Billing and Coding

13.4 The Value of Adhering to Ethical Principles

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