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Purpose:

Codes Ancillary outpatient accounts, diagnosis coding only. Codes Ancillary Service patient type (single visit service such as lab, x-ray, pathology specimen); requires ICD-9 diagnosis coding skills only. Coder reviews the physician script, order or chief complaint as documented in a diagnostic report to determine the appropriate ICD-9 code. Ensures diagnosis codes meet local medical necessity guidelines for ancillary tests that were ordered-- requires knowledge of billing and coding guidelines. Respond to Cirius errors identified by coder ID # on the daily report.

Responsibilities:

+ Refer problem accounts to appropriate coding or management personnel for resolution.

+ Meet appropriate coding productivity and quality standards within the time frame established by management staff.

+ Adhere to internal department policies and procedures to ensure efficient work processes. Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. Maintain continuing education by attending seminars, reviewing updated CPT assistant guidelines and updated coding clinics.

+ Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD-9-CM/ICD-10-CM, CPT and DSM IV codes for outpatient records to ensure accurate reimbursement.

+ Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care are sequenced in order of their clinical significance to accurately assign the appropriate APC/ASC or payment tier under the Prospective Payment system or DSM IV methodology to guarantee accurate reimbursement on UPMC patients.

+ Utilize computer applications and resources essential to completing the coding process efficiently, such as hospital information systems, EHR information systems,encoders and electronic medical record repositories. If applicable, abstract required medical and demographic information from the medical record and enter the data into the appropriate information system to ensure accuracy of the database.

+ Complete work assignments in a timely manner and understand the workflow of the department including routing cases appropriately in the electronic systems.

+ Code by assigning and verifying the principle and secondary diagnoses (ICD-9-CM/ICD-10-CM) and procedures (CPT codes or DSM, IV if applicable) by thoroughly reviewing all documentation available at the time of coding.

+ Complete a non coding time productivity sheet as required/applicable.

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+ High School diploma or GED equivalent required.

+ Successful completion of a recognized coding program and an AHIMA- or AAPC-certified coding program or certificate (e.g., Bidwell Training School or equivalent).

+ Curriculum should include:

+ Anatomy and Physiology

+ Medical Terminology

+ ICD-9-CM / ICD-10

+ CPT Coding Guidelines and Procedures

+ Preferred: Minimum of 6 months hospital coding experience

Licensure, Certifications, and Clearances:

+ Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran