What does it take to become a physician?
Posted: Tue May 20, 2025 9:07 am
Requires further specificity: For example, "renal failure" needs specificity like acute, chronic, or acute on chronic.
Medical Coder (Inpatient or Outpatient):
Second Most Common Originator: Coders review the medical record retrospectively (after the patient has been discharged or the encounter is complete) to assign accurate ICD-10 (diagnosis and procedure) and CPT (procedure and service) codes for billing and data analysis purposes.
Why they query: Similar to gate database CDI specialists, coders query when they encounter documentation that prevents them from assigning the most accurate and specific codes, impacting:
Reimbursement: Correctly capturing the severity of illness leads to appropriate payment.
Quality Metrics: Accurate coding impacts hospital quality scores and performance measures.
Data Accuracy: For public health reporting, research, and internal analytics.
Auditors:
Whether internal or external auditors (e.g., from a payer or regulatory body) reviewing medical records, they may generate queries if they find documentation lacking the specificity needed to support the codes billed or the care rendered.
Case Managers / Utilization Review Nurses (Less common for direct queries).
Medical Coder (Inpatient or Outpatient):
Second Most Common Originator: Coders review the medical record retrospectively (after the patient has been discharged or the encounter is complete) to assign accurate ICD-10 (diagnosis and procedure) and CPT (procedure and service) codes for billing and data analysis purposes.
Why they query: Similar to gate database CDI specialists, coders query when they encounter documentation that prevents them from assigning the most accurate and specific codes, impacting:
Reimbursement: Correctly capturing the severity of illness leads to appropriate payment.
Quality Metrics: Accurate coding impacts hospital quality scores and performance measures.
Data Accuracy: For public health reporting, research, and internal analytics.
Auditors:
Whether internal or external auditors (e.g., from a payer or regulatory body) reviewing medical records, they may generate queries if they find documentation lacking the specificity needed to support the codes billed or the care rendered.
Case Managers / Utilization Review Nurses (Less common for direct queries).