Coder II

Patients Medical Center (PMC) provides inpatient and outpatient medical and surgical services to residents of Pasadena, Deer Park, La Porte, Baytown, and Clear Lake. The facility includes 53 medical/surgical beds, eight ICU beds and three endoscopy rooms, and offers a range of primary and specialized services—wound care, general surgery, gastroenterology, occupational health, heart and vascular, women’s services, diagnostic imaging, outpatient rehab services, and sleep disorders.

Job Responsibilities:

Review clinical documentation and diagnostic results to extract data and apply appropriate international classification system (ICD-9. CM and/or ICD-10. CM/PCS) and CPT (Current Procedural Terminology) codes to multiple categories of inpatients, ambulatory surgery and bedded outpatient records. Utilize advanced working knowledge of coding systems and critical thinking skills in assigning and evaluating appropriateness of MS-DRGs, APR-DRGs, HAC (Hospital Acquired Conditions) and POA (Present on Admission) conditions. Apply knowledge of official coding guidelines and other regulatory guidelines.  Query physicians to ensure appropriate documentation for accurate coding.  Read and interprets multiple healthcare providers’ documentation relevant to coding. Inpatient coding is performed for billing/reimbursement, statistical purposes, internal and external data collection, research and regulatory compliance. Clinical and statistical data is used by Quality Outcomes Management, research, DNV (Det Norske Veritas), Texas Health Care Information Council (THCIC) and other internal and external entities.

1. Translates the clinical care of the patient into a coded format for diagnoses, treatments and procedures on acute inpatient, maternity, newborn, rehabilitation, ambulatory surgery, observation and emergency room patients according to the appropriate international classification system (ICD-9. CM and/or ICD-10. CM) and/or CPT (Current Procedural Terminology) for final billing and/or medical necessity checking, abstracting data when required according to encounter type.
2. Utilizes advanced coding expertise to identify, abstract, sequence and code principal and secondary diagnoses and procedures, discharge disposition,  MS-DRGs, APR-DRGs, POA and HAC conditions when appropriate, to acute inpatient records and specialized records such as rehab and research
3. Utilizes technical coding principles and APC reimbursement expertise to assign identify, abstract, sequence and code (utilizing ICD-9. CM and/or ICD-10. CM and CPT-4. principal and secondary diagnoses and procedures, and discharge disposition for day surgery and emergency room records according to Department procedures and coding guidelines.
4. Enters information into the medical necessity software for Medicare bedded outpatients to determine if tests ordered are medically necessary based on the diagnoses given by the physician.
5. Follows coding compliance policies, official coding guidelines, regulatory requirements and internal coding guidelines affecting the coding process.
6. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
7. Adheres to all St. Luke’s policies, procedures, and standards, within budgetary specifications, including time managements, supply management, productivity and accuracy of practice.
8. Supports department-based goals which contribute to the success of the organization.  
9. Performs concurrent review and coding of in-house patients for the purpose of interim billing. Coordinates work flow and facilitates handling of external and internal requests related to this function.  
10. Communicates with physicians in writing and/or verbally regarding clarification of clinical documentation.
11. Auditing and review of physician coding. Provide feedback and reporting results to the clinic leaders and physician based on audit findings

*Additional responsibility may be assigned by location