How should the guidelines be developed?

The development of Coding Guidelines should follow these steps:

1. Decide on the format of the guidelines.
Guidelines may be organized by Medical Service, ICD-9-CM chapter, body system or any other logical format. Once you have determined the format, it should be applied consistently. In addition, depending on the organization, your guidelines may need to address several different types of coding. For example, in the hospital setting, guidelines should be developed for the following types of coding:
1. Inpatient
2. Ambulatory Surgery
3. Emergency Room
4. Outpatient/Ancillary Services
2. Identify all coding issues addressed in Coding Clinic or the CPT Assistant and reference them in the guidelines. You do not necessarily need to reproduce the entire guideline (although you may want to). The important thing is that your staff knows that for a particular issue they have looked up, they need to abide by Coding Clinic guidance.
3. Identify all coding issues not in Coding Clinic, but addressed in other "quasi-official" resources like those mentioned above. Incorporate these references into your guidelines where possible and applicable.
4. Identify all issues not addressed clearly and comprehensively by any of the sources and develop hospital-specific guidelines for them relying to the extent possible on "quasi-official" sources. This process will be very time consuming, if performed correctly. But remember, that the benefits (in terms of correct billing and compliant coding practices) will definitely exceed any initial costs that may be associated with guideline development.
5. Clinically validate all organization-specific guidelines before implementation. You can do this by determining which medical specialty, service, or hospital committee would be most appropriate (and willing) to review and validate the clinical significance of each guideline. Ideally, for example, a group of cardiologists should validate any coding policies pertaining to coding cardiovascular diagnoses and procedures. The medical staff is usually the most important clinical component in coding guideline validation. There may be some standing committees in your organization (with physician members) that can apply criteria they use to validate coding guidelines. Some examples are:
1. Tissue Committee
2. Transfusion Committee
3. Mortality Review Committee
4. Utilization Review/QA Committee
5. Infection Control
6. Develop a functional Table of Contents as well as an alphabetical index for the policy manual. If the manual is online, it must be in a permanent format that does not allow the user to make changes. In addition, you should build in a search capability for online policies. This will take the place of the alphabetical index in the manual version. Alphabetical indices can be created using various computer publishing programs. Both the table of contents and the alpha index will make the manual more useful and functional for the user.

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