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Coding Process Flow Map

The coding process typically involves patient registration, medical record review, code selection, claim submission, and payment. It can vary by organization but generally includes registering patients, reviewing records, choosing appropriate codes, billing insurance, and receiving payment. Flow charts and descriptions outline the specific steps and requirements.

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chaitanya varma
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157 views

Coding Process Flow Map

The coding process typically involves patient registration, medical record review, code selection, claim submission, and payment. It can vary by organization but generally includes registering patients, reviewing records, choosing appropriate codes, billing insurance, and receiving payment. Flow charts and descriptions outline the specific steps and requirements.

Uploaded by

chaitanya varma
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Coding Process WorkFlow

Clinical coding workflows vary from organization to organization, based on a number of variables,
such as the amount of non-coding activities performed by coders or the location where the patient
encounter occurs.

Coding is highly interdependent upon the multiple steps that are taken during the patient encounter
process within each healthcare organization.

Coding process typically is made up of a set of steps that start with the patient registration process
and end when the claim is paid. Automation is typically not applicable to the entire process but can
be applied to various steps within the process.

A coding workflow diagram is a pictorial representation of the sequence of steps that are taken by
each person or group of people involved in the coding process, shown in the order that they are
performed.

1
Coding Process Flow Chart Example

The coding flow chart is a chart and/or text policy which describes the process by which
coding is done in the facility.

Flow Chart Example 1:

Patient
Encounter
Patient Review of
Statement Medical
Records

AR Follow-up
Selection of
after Appropriate
submission to Diagnosis and
insuracnce Procedure
company Codes

Submission Assignment
of Claims to
Insurance of Code
Company Numbers
Generation
of Claim

Flow Chart Example: 2

2
Text Format Coding Process Example:
The main task of a medical coders is to review clinical statements and assign standard codes using
CPT®, ICD-9/10-CM, classification systems. The diagnoses and procedure codes are taken from
medical record documentation, such as transcription of physician's notes, laboratory and radiologic
results, etc.

Medical coders help ensure the codes are applied correctly during the medical billing process, which
includes abstracting the information from documentation, assigning the appropriate codes, and
creating a claim to be paid by insurance carriers from CPT, HCPCS, and ICD-9/10- CM Coding.

Each patient’s account is to be released, or re-released, for billing only when all of the following are
met:

1. All ICD-9-CM/ ICD-10-CM and Outpatient Procedure CPT/HCPCS codes (including select modifiers)
that are submitted for billing purposes under provider number must be assigned by a Coder, who is
adequately supervised, as well as trained and oriented, as appropriate, to the type of Coding to be
assigned.

2. All ICD-9/10-CM and Outpatient Procedure CPT/HCPCS codes to be reported on the patient’s claim
are supported by legible, complete, clear, consistent, precise and reliable provider documentation.

3. A sufficient clinical documentation set exists in the patient record from which to assign a complete
set of codes.

4. Diagnoses and procedure codes are assigned and sequenced appropriately according to Official
Coding Guidelines.

5. Other claim elements including the discharge disposition code, admission status (inpatient or
outpatient) and admit/discharge dates as recorded in the patient accounting system correlate with
documentation in the patient’s medical record.

6. Accounts with identified discrepancies in one or more of the above areas must not be released for
billing until the discrepancy is resolved and the account can be billed with a complete, accurate and
compliant code set.

7. When a discrepancy is detected with the Coding on a previously submitted claim, the department
must undertake reasonable efforts to correct the deficiency and prevent the defect from reoccurring
on future claims. Overpayments must be corrected and resubmitted to the payer.
Reference: AHIMA, HIM Body of Knowledge

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