As an inpatient coder, you have been instructed b your coding supervisor to code all debridement’s as excisional. You are not comfortable with this practice and tried to discuss it with her, but she stated that you were to follow her instructions and not issue queries. You went to the HIM director, who only half-listened to your concerns, saying that the coding supervisor must have a good reason for the instruction. The other coders are following her instructions without questions.
You are reluctant to get into trouble for not following the instructions and equally worried that the coding supervisor will retaliate against you in some manner if you report this practice.
How to solve
HIMA 200 AMU Impatient Coder Case Study
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The situation described presents a challenging ethical dilemma for the medical coder. It involves following instructions from a supervisor that may conflict with the coder’s professional judgment and standards. In addressing this issue, it is important to prioritize patient care and accurate coding while navigating the hierarchal structure of the organization.
As a medical professional, our primary responsibility is to ensure patient safety and provide accurate healthcare records. In this case, the coder has concerns about coding all debridements as excisional, despite knowing that it may not align with best practices or coding guidelines. As such, it is crucial to seek resolution in an ethical and professional manner.
First, the coder attempted to discuss the matter with their coding supervisor. However, the supervisor dismissively instructed the coder to follow the given instructions without questioning. This response indicates a lack of openness to dialogue and potentially compromises the integrity of the coding process.
Recognizing the importance of resolving the issue, the coder then approached the HIM director. Unfortunately, the HIM director seemed to provide little attention to the coder’s concerns, implying that the supervisor’s instructions should be blindly followed. This response is unsatisfactory, as it fails to address the issue and undermines the credibility of the coding process.
Given the circumstances, the coder finds themselves faced with a dilemma. On one hand, they may comply with the supervisor’s instructions, compromising their professional integrity and potentially compromising patient care. On the other hand, reporting the issue could lead to potential trouble or retaliation from the coding supervisor.
To responsibly address this situation, the coder should consider taking the following steps:
1. Document the concern: Keep a detailed record of the instructions received from the coding supervisor and subsequent interactions with the HIM director. This documentation will serve as evidence when discussing the matter further.
2. Consult professional resources: Review coding guidelines, industry publications, and authoritative sources to validate their concerns. Gathering supporting evidence will reinforce the coder’s professional judgment.
3. Seek an alternate opinion: Consult with trusted colleagues or professional organizations to gain insights and perspectives on the coding practice. This will help validate concerns and build a solid foundation for discussions.
4. Arrange a formal meeting: Request a meeting with the coding supervisor, HIM director, or both. Present the concerns clearly and professionally, incorporating the supporting evidence and industry best practices. Emphasize the importance of accurate coding for optimal patient care.
5. Pursue higher authority if necessary: If the initial meeting fails to resolve the issue or if the coder faces retaliation, they should escalate the matter to a higher authority within the organization, such as a compliance officer, chief medical officer, or hospital administrator.
6. Protect whistleblower rights: Understand the protections and rights afforded to whistleblowers, ensuring personal safety and job security when reporting concerns related to improper coding practices.
In conclusion, the coder is faced with a challenging ethical dilemma requiring careful navigation and action. By documenting concerns, consulting professional resources, seeking alternate opinions, and engaging in open dialogue, the coder can work towards a resolution that upholds professional standards, patient care, and integrity in the coding process.
