ahima-perspectives > Paper Categories > Coding & Reimbursement

Coding & Reimbursement

Risk of Duplicate ICD Codes for Orthopedic and Injury Related Research

By Gregory Benes, BS

The World Health Organization’s International Classification of Diseases (ICD) has become the international standard diagnostic classification for reporting morbidity and mortality. In 2015, the United States transitioned from the 9th to 10th Revision. The update was necessary due to major...
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Resident and Family Physician Perspectives on Billing: An Exploratory Study

By Serena Chin, MBA, MD; Toni Li, BSc; Maximilien Boulet, MD; Kelly Howse, MD; and Akshay Rajaram, MMI, MD

Within revenue cycle management, billing is an important activity for physicians with financial implications across remuneration models. We assessed the self-reported billing confidence of residents and attending physicians practicing at an academic family health team in a single payer...
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The Natural History of CDI Programs: A Metric-Based Model

By Howard Rodenberg, MD, MPH, and James D. Campbell, MD

The success or failure of a clinical documentation integrity (CDI) program is often evaluated using a designated set of metrics. However, these metrics change over time, and an understanding of these changes is critical to properly judge the efficacy of the CDI effort. The authors propose a...
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Procedure Code Utilization for Vascular Access Device Placement in the Inpatient Setting: A Retrospective Analysis

Erica DeBoer, RN, MA, CCRN-K, CNL, and Kimberly Alsbrooks, BSN, RN, RT (R), VA-BC

Vascular access (VA) is essential to inpatient care, and the documentation/coding practices for vascular access device (VAD) placement procedures remain unexplored. Accurate documentation may present benefits for patients, providers, and researchers. A retrospective analysis was performed in...
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The Coding Impact of Acute Kidney Injury in Pediatric Hospital Documentation

Ella Tierney; Ayesha Irani, DO; Meena Iyer, MD; and Alyssa A. Riley, MD, MEd

Acute kidney injury (AKI) increases patient morbidity and mortality. In value-based care, the documented and coded diagnoses during hospitalization influences an encounter’s relative weight (RW), including severity of illness (SOI), and risk of mortality, which ultimately determines...
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Improvements for the Prior Authorization Process for Elective Surgical Procedures at an Academic Medical Center

By Karen Y. Marble, MHS; Genie R. Briggs MHS; and Xiaoshan Z. Gordy, PhD

Prior authorization is an approval process to ensure that services provided by healthcare organizations will be reimbursed by insurance carriers. Prior authorization denials can result in revenue loss. Due to multiple prior authorization issues, over $21 million in charges was denied, and...
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