WGU C807 Task 1 Coding Management |Latest Update with Complete Solution

Coding..Management



WGU C807 Task 1 Coding Management |Latest
Update with Complete Solution


Class C807 Healthcare Compliance
Task 1: Coding Management
Instructor: Junius Logan




A1...Inpatient..and..Outpatient..Coders

Inpatient..and..outpatient..coders..have..one..main..goal:..to..ensure..that..documentation..is..ac

curately..coded..and..bill..insurance..to..ensure..proper..reimbursement.. . What..are..inpatient..coding..

and..outpatient..coding?..It..all..has..to..do..with..the..setting..of..care:..Inpatient..includes..overnight..ho

spital..stays..or..care..facilities,..while..outpatient..is..usually..but..not..limited..to..office..visits,..labs,..c

hemotherapy,..and..outpatient..surgeries,..as..well..as..outpatient..physical,..occupational,..and..speech

..therapy...Depending..on..the..setting..will..determine..what..codes..and..coding..tasks..will..be..perform


ed.

Inpatient..and..outpatient..coders'..responsibilities..are..different...In..an..inpatient..setting,..an

..inpatient..coder..reviews..the..entire..medical..document..from..admission..to..discharge,..while..outp


atient..coders..review..documents..from..the..visit..and..code..each..service..rendered...If..the..documen

tation..is..unclear..or..inaccurate,..coders..will..query..the..physicians..and..wait..till..they..have..the..pro

per..information..documented..before..coding...Inpatient..coders..can..code..unconfirmed..diagnoses..

and..often..use..the..principal..diagnosis,..while..outpatient..codes..are..first..listed..(Thomas,..2024)...T

o..code..diagnosis,..both..inpatient..and..outpatient,..will..use..the..ICD-10-

1

, Coding..Management
CM...Both..settings..use..ICD-10-

CM..for..coding..diagnosis..because..it..is..the..official..guideline..for..coding..and..reporting..(Thomas,..

2024)...However,..when..coding..for..procedures,..outpatients..utilize..the..Current..Procedural..and..T

erminology..(CPT),..while..Inpatient..coders..will..use..ICD-10-PCS.

Once..it..is..time..to..enter..coding..into..the..payer..or..claims..system..depending..on..the..settin

g..determines..which..payment..system..will..be..used...Inpatient..coders..will..enter..the..information..i

nto..the..Inpatient..Prospective..Payments..System..and..Diagnosis..Related..Groups,..while..Outpatient

..uses..the..Outpatient..Prospective..Payment..System..and..the..Ambulatory..Payment..System..(Thom


as,..K,..2024).

There..are..multiple..certifications..a..person..interested..in..coding..can..obtain,..such..as..a..Cer

tified..Coding..Specialist,..which..can..be..used..in..an..inpatient..and..outpatient..setting..that..both



hospital..and..medical..providers..use..for..reimbursement..from..Medicare..and..Medicaid..(AHIMA..

Certification,..n.d.)...Certified..Coding..Specialist-

physician..allows..coders..to..code..in..physician..offices,..group..practices,..multi-

specialty..clinics,..and..centers..(AHIMA..Certification,..n.d.)...CPC..is..achieved..through..AAPC,..and

..certified..professional..coding..is..the..standard..for..medical..coding..in..a..physician's..office..setting...


Both..outpatient..and..inpatient..coding..have..their..challenges,..so..when..picking..a..career,..it..is..esse

ntial..to..look..at..the..pros..and..cons..of..each,..which..will..determine..what..certification..is..obtained.

A2...CDI..Program

According..to..(Oach..&..Watters,..2020),..clinical..documentation..integrity,..most..known..as

..clinical..documentation..improvement,..is..a..process..to..accurately..represent..a..patient's..clinical..st


atus,..which..is..then..written..into..coded..data...The..Clinical..Documentation..Integrity..Program..has.

.many..different..purposes...This..includes..a..review..of..the..health..records..for..conflicting..and..inco

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