ComplaintsforSpringhill Medical Center

• Initial Complaint

  08/23/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  The hospital missed coded patients' cancer conditions which resulted in non-payment of the patient's cancer insurance policy. After being contacted they refuse to make corrections.

  Business response

  09/03/2024

  Upon review, it has been determined that appropriate code assignment was applied and that all provider documentation was utilized at the time of coding. 
  
  Code assignment is dependent on numerous stringent guidelines and provider documentation entered in the medical record. We acknowledge the complaint and are apologetic for the frustration, yet our requirements to follow guidelines for diagnosis code assignment based on provider documentation cannot be overemphasized. 
  
  I am sharing excerpts taken from the ICD-10-CM Official Guidelines for Coding and Reporting to frame the context of our findings and to demonstrate our commitment to providing our patients with the highest level of customer service possible including accurately reflecting the complexity and severity of our patient's condition based on provider documentation and the final code set. 
  
  The Centers for ******** and ***************** (CMS) and the National Center for Health
  Statistics (NCHS), two departments within the *********************************** of Health and ************** (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the ***************************** (AHA), the ************************************************** (AHIMA), CMS, and NCHS.
  
  The guidelines state: These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself a joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures and that without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.

  *****************************
  Director, Health Information Management 
  Springhill Medical Center
  Office: ************

   

   

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