C A S E
A S S E S S
S T U D Y
3 :
E T H I C A L
S TA N D A R D S
O F
P R A C T I C E
AYA N N A
HARRISON
HIIT
102
CASE SCENARIO
You are a newly hired medical coding specialist working for a large regional physician group practice. Shortly after
being hired, you are informed that the practice is behind on filing claims. It has been determined that the delay in
filling claims is due to delinquent physician documentation. You inform the practice that reimbursements are in
jeopardy due to timely filling standards. The coding manager verbally instructs you to take the following actions in
relation to the problem:

She instructs you not to wait until the physician completes his or her documentation if the encounter occurred
more than 15 business days prior to the calendar date.

She instructs you to use the condition on the billing sheet or triage sheet to abstract your first listed diagnosis
code if physician has not documented the first listed diagnosis yet.

She instructs you to cut and paste from prior EHR notes making it easier for the physician to complete his or her
documentation.

She instructs you to blindly code for the mid-level outpatient Evaluation and Management CPT code if the
document is incomplete or missing.
TA S K 1 . 0 : E T H I C A L D E C I S I O N - M A K I N G
PROCESS TOOL
Ethical Issue: The coding manager has instructed the medical coding specialist to take actions that may compromise the accuracy and integrity of medical coding
and billing due to delinquent physician documentation.
•
Assessment of Ethical Standards:
1.
Identify the Problem or Dilemma: The problem is a delay in filing claims due to delinquent physician documentation, which could impact reimbursement.
2.
Gather Information: The coding manager has provided specific instructions to the medical coding specialist, including not waiting for physician documentation,
using billing or triage sheets for diagnosis codes, cutting and pasting from prior EHR notes, and blindly coding for outpatient E&M CPT codes.
3.
Identify the Stakeholders: Stakeholders include the medical coding specialist, the coding manager, physicians, the physician group practice, patients,
insurance companies, and regulatory authorities.
4.
Consider Possible Courses of Action:
1.
Comply with the coding manager's instructions, risking accuracy and ethical coding standards.
2.
Communicate the issue to the coding manager and seek a more ethical and compliant approach.
3.
Collaborate with physicians to improve documentation practices.
4.
Develop a workflow to expedite physician documentation without compromising accuracy.
T A S K 1 . 0 C O N T.
5. Examine the Consequences:
1. Following the coding manager's instructions may expedite claims filing but could lead to coding inaccuracies,
potential legal and financial consequences, and damage to the practice's reputation.
2. Collaborating with physicians to improve documentation practices may take time but ensures ethical coding and
billing.
6. Make a Decision: The medical coding specialist should choose a course of action that upholds ethical
coding standards and compliance. This may involve communicating concerns to the coding manager,
collaborating with physicians, and developing a workflow to address documentation delays while
maintaining coding accuracy.
7. Act and Reflect: The medical coding specialist should act in a manner consistent with ethical coding
standards, even if it means challenging the coding manager's instructions. Reflect on the decision and its
impact on the practice's ethical standing.
TA S K 2 . 0 : A H I M A S TA N D A R D S F O R
E T H I C A L C O D I N G R AT I O N A L E T O O L
Ethical Issue: The coding manager's instructions may compromise the accuracy and integrity of medical
coding and billing.
• Evaluation of Ethical Standards:
• AHIMA Standards for Ethical Coding:
1. Accuracy: The coding manager's instructions may lead to coding inaccuracies, violating the accuracy
standard. Blindly coding without complete documentation is not in line with ethical coding practices.
2. Integrity: The instructions to cut and paste from prior EHR notes may compromise the integrity of the
medical record. This violates the integrity standard, which requires accurate and complete
documentation.
3. Compliance: The instructions to blindly code for outpatient E&M CPT codes when documentation is
incomplete may violate compliance standards, as it could lead to upcoding or incorrect coding.
T A S K 2 . 0 C O N T.
4. Confidentiality: While not explicitly addressed in the scenario, maintaining patient confidentiality is a
fundamental ethical principle. Cutting and pasting from prior records without regard for sensitive patient
information may breach confidentiality.
5. Professionalism: The medical coding specialist is expected to maintain professionalism by adhering to
ethical coding standards and challenging instructions that may compromise professionalism.
Ethical Rationale: The coding manager's instructions do not align with AHIMA's Standards for Ethical
Coding, specifically the standards related to accuracy, integrity, compliance, and professionalism. Coding
accurately and with integrity, ensuring compliance, and maintaining professionalism are fundamental to
ethical medical coding practices. The instructions provided by the coding manager could lead to coding
inaccuracies, non-compliance, and potential legal and financial consequences, all of which conflict with
AHIMA's ethical coding standards.