ICD9 codes is a nursing duty?

[superwoman27]

At our hospital they requrie all nursing staff in all departments to enter ICD9 billing codes on the patient when we admit the patient as part of our admitting process. Is this normal? We have not been trained in proper coding use so we just kind of look at the patient's health history and enter those....or whatever other illness the patient claims. I have never heard of nursing staff being required to do billing codes - do other hospitals do this?

[ZenLover, MSN, RN, NP]

You are correct. I am sure hospitals are looking at how they can use the trained and educated staff they have versus investing in yet another level of overhead in terms of employee overhead. It doesn't help that through HIT centers sponsored by the gov't that computer programs designed to share all of your medical records with the gov't or Medicare (however you want to look at that) are promising Hospitals and management in physician groups that these new programs all but eliminate the overhead in professional billing staff.

I am not saying it will work or that it is fair that the buck keeps getting passed, but even with a couple of A&P classes and a BIO, you still don't necessarily have the training you need to accurately assess what a primary and secondary diagnosis is on a patient. Think in terms of a long term ill patient with cancer in remission coming in and being treated most immediately for acute kidney failure related to previous chemo treatment. It can quickly become complicated trying to figure out what should be the primary diagnosis attached to that IV bag you just hung that will get it paid by the Ins co.

Of course insurance companies do it on purpose and gov't regulation lets them. This in turn only encourages your hospital to tighten their purse to the point of being painful for you in workload and expectation of what you will do...Cr*p rolls down hill and there is a never ending supply from Aetna and Washington. In my humble opinion of course.

You just do the best you can for the patient that needs you and try not to let the politics, red tape and HR drive you crazy in the process.

[Ginger's Mom, MSN, RN]

It gets better,Icd9 are becoming obselete, OCD 10 will be the standard.

[NotFlo]

We have do do these for labs, and all I've got to go by is a 1 page handout. I ended up using the wrong code one day and got hauled into the office- nurse manager fussing her brains out.

I asked her, "Well do YOU know the correct code?"

Turns out she had no idea either. -.-

It's complicated material, don't expect me to do something without giving me any resources.

Yes, we have to do these for labs too. If one of the nurses forgets to put the codes on it comes back to the unit secretary (who has no training) to try to fill them all in and send them back to the lab.

[Do-over, ASN, RN]

I did not even know what an ICD9 code was before reading this post.

[tiroka03, LPN]

I have had to struggle with this same issue. The latest word from my boss is to put what you have to in order to push a lab through, but then document onthe 24 hour report and ask for the code specialist to correct it. I am not comfortable with this either.

[ktwlpn, LPN]

I'm in LTC and we justwent techno (yay for us!) Every single order we enter requires the appropriate code before it's complete.The docs are refusing to enter orders at this point because our system requires a little more then the 3 clicks like they are used to at the area acute cares. Now we are back to tons of verbal orders.One step forward and two steps back..But we are coders......

[SappyRN]

We aren't given any book to look through for these codes? For example we type in diabetes and countless different diabetes codes show up with weird abbreviations we aren't familiar with so we just pick one that seems right.

If your actual coding is used for the Medicare billing and it is wrong you cN be personlly fined for fraud. You may want to ask them for an inservice.

[molliemjae]

I recently started a new nursing job in clinic and I am learning how to put in billing codes for my doc. Looks like it caught on. Are there any suggestions for first timers

[klone, MSN, RN]

I work in a clinic, and the providers are expected to fill out their own superbill, myself included (I have my own patient load). This position was the first time I was introduced to billing/coding. Before this job, I had never heard of "incident to" or "level" visits. So no, as a hospital RN, I have NEVER heard of the nursing staff having to deal with coding/billing.

[firstinfamily, RN]

I also did ICD9 codes with lab slips, usually the admissions officer did them for the charts. Yes, it is something the facility can be held liable for as if the wrong code is entered and they are over-reimbursed that would be considered "fraud" and could be persecuted by law. They are putting you at risk by asking you to do this. There is a huge ICD9 code book published yearly or more frequently that has all the listings of ICD codes. I also did MDS and coding was expected to be correct for proper reimbursement and that can also be persecuted by Medicare if not done correctly. It sounds like this facility needs to hire an admissions officer to keep their records accurate instead of putting their nurses at risk.