Question

multiple select question

select all that apply

which of the following are true of compliance in the area of coding?

official guidelines need to be followed only after claims are rejected.
official guidelines should be followed when codes are assigned.
diagnoses and services documented should be linked for medical necessity.
diagnostic and procedure codes must be checked for errors.
additional codes should be included to ensure payment.

Explanation:

Analyze the core question

The question asks to identify the true statements regarding compliance in the area of medical coding. Coding compliance involves adhering to official rules, guidelines, and laws to ensure accurate billing and prevent fraud or abuse.

Evaluate the first option

Using the Medical Coding Verification knowledge point

• "Official guidelines need to be followed only after claims are rejected."
• This statement is incorrect. Compliance guidelines must be followed proactively during the initial coding process, not just reactively after a claim rejection.

Evaluate the second option

Using the Medical Coding Verification knowledge point

• "Official guidelines should be followed when codes are assigned."
• This statement is correct. Compliance requires that official coding manuals (such as ICD-10-CM, CPT, and HCPCS) and guidelines are strictly adhered to at the time of code assignment.

Evaluate the third option

Using the Medical Coding Verification knowledge point

• "Diagnoses and services documented should be linked for medical necessity."
• This statement is correct. Establishing medical necessity by linking the diagnosis code to the corresponding procedure/service code is a fundamental requirement of coding compliance.

Evaluate the fourth and fifth options

Using the Medical Coding Verification knowledge point

• "Diagnostic and procedure codes must be checked for errors."
• This statement is correct. Verification and auditing of codes to detect and correct errors before submission is a key component of a coding compliance program.
• "Additional codes should be included to ensure payment."
• This statement is incorrect. Adding unnecessary or undocumented codes to maximize reimbursement (upcoding) is fraudulent and violates compliance regulations.

Answer:

• Official guidelines need to be followed only after claims are rejected.
• Official guidelines should be followed when codes are assigned. (Correct answer)
• Diagnoses and services documented should be linked for medical necessity. (Correct answer)
• Diagnostic and procedure codes must be checked for errors. (Correct answer)
• Additional codes should be included to ensure payment.