Health information coding is the transformation of verbal descriptions of diseases, injuries, and procedures into numeric or alphanumeric designations. Coders review and analyze health records to identify relevant diagnoses and procedures for distinct patient encounters.
Requirements
- Reviews the content of the medical record for hospital and professional inpatient or outpatient records to identify principal diagnosis, secondary diagnoses and procedures performed
- Translates diagnostic and procedural phrases utilized by healthcare providers into coded form
- Determines the codes for all diagnoses and procedures using the Encoder software program
- Assigns the appropriate DRG and codes based on hospital and professional coding guidelines
- Queries physicians as needed to clarify documentation within the patient’s record
Benefits
- Healthcare benefits from day one, including vision, dental, and domestic partners
