AHIMA Revises Standards of Ethical Coding

The American Health Information Management Association (AHIMA) House of Delegates approved the newest version of its Standards of Ethical Coding on Dec. 12, 2016. 

This document provides a solid foundation of guidance in relation to ethical coding practices and actions. The Standards are a form of guidance that promotes a level of quality and acceptable behavior for the coding professional.  The prior version of the Standards dates back to 2008, and we all know a lot has occurred in healthcare and coding since then, not the least of which is ICD-10. 

AHIMA formed a task force back in April 2016 to work on the review of and revisions to the Standards of Ethical Coding. The task force had a membership made up of 25 health information management (HIM) coding professionals from across the industry and from across practice settings, including academia. These revised Standards of Ethical Coding reflect the current healthcare environment and modern coding practices. 

The Standards document is in two parts; the first part includes the standards and the second contains the guidelines and examples. Additionally, definitions have been added for some key words and terms used throughout for consistency and continuity. When we think of “coding professional” in reference to these Standards, this term embraces “individuals, whether credentialed or not; including but not limited to coding staff, coding auditors, coding educators, clinical documentation improvement (CDI) professionals, and managers responsible for decision-making processes and operations as well as HIM/coding students.”There are a total of 11 principles and these include the following:

1. Apply accurate, complete, and consistent coding practices that yield quality data.
2. Gather and report all data required for internal and external reporting, in accordance with applicable requirements and data set definitions.
3. Assign and report, in any format, only the codes and data that are clearly and consistently supported by health record documentation in accordance with applicable code set and abstraction conventions and requirements.
4. Query and/or consult as needed with the provider for clarification and additional documentation prior to final code assignment in accordance with acceptable healthcare industry practices.
5. Refuse to participate in, support, or change reported data and/or narrative titles, billing data, clinical documentation practices, or any coding-related activities intended to skew or misrepresent data and their meaning that do not comply with requirements.
6. Facilitate, advocate, and collaborate with healthcare professionals in the pursuit of accurate, complete, and reliable coded data, and in situations that support ethical coding practices.
7. Advance coding knowledge and practice through continuing education, including but not limited to meeting continuing education requirements.
8. Maintain the confidentiality of protected health information in accordance with the Code of Ethics.
9. Refuse to participate in the development of coding and coding-related technology that is not designed in accordance with requirements.
10. Demonstrate behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities.
11. Refuse to participate in and/or conceal unethical coding, data abstraction, query practices, or any inappropriate activities related to coding, and address any perceived unethical coding related practices.

Although the examples for each principle are not all-inclusive, they do address a wide range of behaviors and situations that apply to all settings, including post-acute care and physician offices/clinics. The coding professional faces daily challenges that can influence one’s behavior and/or actions, so taking the Standards and applying them in an effort to foster ongoing ethical excellence will require strong dedication. 

Take the time to read and discuss the new Standards with your coding staff, management, and leaders. After reading the new Standards of Ethical Coding you should be able to interpret them and know how to use and apply them in your work or academic environment. 

This resource is now available for the healthcare industry to absorb and utilize across all healthcare settings. You can find the new version of the Standards of Ethical Coding posted online in the HIM Body of Knowledge section of the AHIMA website: (http://bok.ahima.org/PdfView?oid=301963). The new Standards are also posted on ahima.org under the Ethics section.