Official basic coding guidelines for both the inpatient and outpatient
settings were developed by the Federal Government. In addition to these
basic guidelines, the only officially recognized source for hospital
based-coding guidelines is the Coding Clinic published by the American
Hospital Association. Coding Clinic Guidelines are fairly comprehensive
and date back to 1985, however, they will not address every issue that
every coder will encounter in the process of coding. In addition, the
officially recognized coding guidelines for CPT coding come from the CPT
Assistant published by the American Medical Association. To prevent
haphazard coding practices, each organization will need to look to
secondary sources or "quasi-official" sources for coding
guidance. These include:
- The provider’s Fiscal Intermediary
- The OIG's Compliance Program Guidance
- Applicable versions of the Federal
Register (only refer to this document if Coding Clinic has not
ruled on an issue – as Coding Clinic will over-rule the Federal
Register on particular coding issues)
- Guidance from the American Health Information Management Association’s
(AHIMA)
coding experts for ICD-9-CM and CPT advice or the American Academy of
Professional Coders’ (AAPC)
coding experts for CPT issues.
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