Question

Your legal team has approached you to work on a team to resolve a lawsuit for incorrect medical coding which the patients' claim has led to higher expenses. Explain how you can use some quality tools to research the situation for legal. Provide examples of how you would apply the tools.

Answer 1

Lawsuit for incorrect medical code is always important. Coded data is used for many basic functions, including recovery, cost, policies, clinical and financial decisions, health policy, public health monitoring and research. Recently, medical coding has become increasingly important as it addresses the quality of care and data that are publicly reported.

There are many challenges regarding this increasing importance, including new collection and reporting and the interplay between established guidelines and the need for different quality measurement. Expectations for coding professionals are likely to increase in the coming years. The coding experts will need to join with other doctors and health professionals to work together to improve the accuracy of coded data to meet these new requirements.
For example, a patient admitted to treating obstructive pulmonary disease due to dehydration due to non-adherence to dialysis regulations should be assigned a primary diagnosis of heart failure. In return, the case has been marked as inadequate heart failure and is a basic measure for national patient safety goals because patients are not treated with ACE inhibitors. Treatment of fluid overload in patients with advanced kidney disease is dialysis, not ACE therapy. This discrepancy between code guidelines and quality measures causes possible tensions between the two departments.