Maintains a working knowledge of CPT-4, ICD-10-CM, and ICD-10-PCS coding principles, governmental regulations, UHDDS (Uniform Hospital Discharge Data Set) guidelines, AHA coding clinic updates, and third-party requirements regarding coding and documentation guidelines
Knowledge of Physician query process and ability to write physician queries in compliance with OIG and UHDDS regulations
Knowledge of MS-DRG (Medicare Severity Diagnosis Related Groups), MDC (Major Diagnostic Categories), AP-DRG (All Patient DRGs), APR-DRG (All Patient Refined DRGs) with hands-on experience in handling MS-DRG
Knowledge of CC (complication or comorbidity) and MCC (major complication or comorbidity) when used as a secondary diagnosis
Understanding and exposure to Clinical Documentation Improvement (CDI) program to work in tandem with MS-DRG
Hands-on experience in any of the Encoder tools specific to Hospital coding, such as 3M, Trucode, etc., is preferred.
The coders assigned on the project would be reviewing Inpatient and observation medical records, determine and assign accurate diagnosis (ICD-10-CM) codes and Procedure codes (ICD-10-PCS and/or CPT) codes with appropriate modifiers in addition to reporting any deviations promptly.