What is the AAPC code of ethics?

The American Academy of Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC) each have ethical standards for medical coders.  A list of those attributes and standards along with links to their websites is included in this blog post.

Ethical Coding is important AAPC coding Ethics:
Integrity, Respect, Commitment, Competence, Fairness, Responsibility

AHIMA coding Ethics: Coding professionals should: 1. Apply accurate, complete, and consistent coding practices for the production of high-quality healthcare data. 2. Report all healthcare data elements (e.g. diagnosis and procedure codes, present on admission indicator, discharge status) required for external reporting purposes (e.g. reimbursement and other administrative uses, population health, quality and patient safety measurement, and research) completely and accurately, in accordance with regulatory and documentation standards and requirements and applicable official coding conventions, rules, and guidelines. 3. Assign and report only the codes and data that are clearly and consistently supported by health record documentation in accordance with applicable code set and abstraction conventions, rules, and guidelines. 4. Query provider (physician or other qualified healthcare practitioner) for clarification and additional documentation prior to code assignment when there is conflicting, incomplete, or ambiguous information in the health record regarding a significant reportable condition or procedure or other reportable data element dependent on health record documentation (e.g. present on admission indicator). 5. Refuse to change reported codes or the narratives of codes so that meanings are misrepresented. 6. Refuse to participate in or support coding or documentation practices intended to inappropriately increase payment, qualify for insurance policy coverage, or skew data by means that do not comply with federal and state statutes, regulations and official rules and guidelines. 7. Facilitate interdisciplinary collaboration in situations supporting proper coding practices. 8. Advance coding knowledge and practice through continuing education. 9. Refuse to participate in or conceal unethical coding or abstraction practices or procedures. 10. Protect the confidentiality of the health record at all times and refuse to access protected health information not required for coding-related activities (examples of coding-related activities include completion of code assignment, other health record data abstraction, coding audits, and educational purposes).

11. Demonstrate behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities.

Happy Ethical Coding!

Commitment to ethical professional conduct is expected of every AAPC member.  The specification of a Code of Ethics enables AAPC to clarify to current and future members, and to those served by members, the nature of the ethical responsibilities held in common by its members.  This document establishes principles that define the ethical behavior of AAPC members.  All AAPC members are required to adhere to the Code of Ethics and the Code of Ethics will serve as the basis for processing ethical complaints initiated against AAPC members.

Please refer to the Code of Ethics document for more details. 

Members of the American Academy of Professional Coders shall be dedicated to providing the highest standards of professional coding and billing services to employers, clients, and patients.  Professional and personal behavior of AAPC members must be exemplary.

AAPC members shall maintain the highest standard of personal and professional conduct. Members shall respect the rights of patients, clients, employers, and all other colleagues.

Members shall use only legal and ethical means in all professional dealings and shall refuse to cooperate with, or condone by silence, the actions of those who engage in fraudulent, deceptive, or illegal acts.

Members shall respect and adhere to the laws and regulations of the land and uphold the mission statement of the AAPC.

Members shall pursue excellence through continuing education in all areas applicable to their profession.

Members shall strive to maintain and enhance the dignity, status, competence, and standards of coding for professional services.

Members shall not exploit professional relationships with patients, employees, clients, or employers for personal gain.

Above all else we will commit to recognizing the intrinsic worth of each member.

This code of ethical standards for member of the AAPC strives to promote and maintain the highest standard or professional service and conduct among its members.  Adherence to these standards assures public confidence in the integrity and service of professional coders who are members of the AAPC.

Failure to adhere to these standards, as determined by AAPC, will result in the loss of credentials and membership with the American Academy of Professional Coders.

To register an ethics violation, please refer to http://www.aapc.com.

AAPC’s Professional Code of Ethics sets standards for campaign and business practices to promote integrity and confidence in the American political system. All AAPC members are required to sign the Code of Ethics annually, and to live and work by the standards it sets.

AAPC takes adherence to its Code seriously. If you have reason to believe an AAPC member has violated any provision of this code, you may initiate a formal Complaint.

As a member of the American Association of Political Consultants, I believe there are certain standards of practice which I must maintain. I, therefore, pledge to adhere to the following Code of Professional Ethics:

1. 1. I will not indulge in any activity which would corrupt or degrade the practice of political consulting.
   2. I will treat my colleagues and clients with respect and never intentionally injure their professional or personal reputations.
   3. I will respect the confidence of my clients and not reveal confidential or privileged information obtained during our professional relationship.
   4. I will use no appeal to voters which is based on racism, sexism, religious intolerance or any form of unlawful discrimination and will condemn those who use such practices. In turn, I will work for equal voting rights and privileges for all citizens.
   5. I will refrain from false or misleading attacks on an opponent or member of his or her family and will do everything in my power to prevent others from using such tactics.
   6. I will document accurately and fully any criticism of an opponent or his or her record.
   7. I will be honest in my relationship with the news media and candidly answer questions when I have the authority to do so.
   8. I will use any funds I receive from my clients, or on behalf of my clients, only for those purposes invoiced in writing.
   9. I will not support any individual or organization which resorts to practices forbidden by this code.
   10. I will be committed to a vibrant democracy including ensuring free and fair elections that obey all laws and I will not degrade American Democracy. The continual and peaceful democratic process is central to our profession and a necessary part of our nation.

File a Code of Ethics Complaint

By Ida Landry, MBA, CPC

Knowing coding and billing rules, and following them with integrity, is key to success.

Compliance is an important part of medical coding. Novice coders are instructed early on that “correct coding is the No. 1 objective,” and “if it isn’t documented, it wasn’t done.” These rules of thumb are the backbone of compliant coding for all coders. To be an effective coding compliance professional, however, you must also stay current with coding and billing regulations and have a solid code of ethics.

Know How Compliance Fits into Today’s Coding and Billing

Payment is generated or denied by the guidelines, rules, and federal laws payers use to direct their part of the revenue cycle. In the past, payers acted as compliance overseers, but in recent years legislation like the Tax Relief and Health Care Act of 2006 and the Affordable Care Act of 2010 have mandated more oversight regarding documentation and coding compliance. An example of the reimbursement climate resulting from these regulations is increased scrutiny by recovery audit contractors (RACs). “From 2005 through 2008, the Medicare RACs identified and corrected over $1 billion in improper payments. The majority, or 96 percent, of the improper payments were overpayments, while the remaining 4 percent were underpayments,” according to the Federal Register, 2011, p. 57808.
A byproduct of increased oversight is the establishment of more compliance departments and restructuring in health care organizations to meet the growing need for proper coding and documentation.

Key Compliance Principles

To understand fully coding compliance and be an effective medical coding compliance professional, you must have a commitment to the core principles, rules, guidelines, and laws that embody medical compliance. This is the first objective to successfully mastering compliance elements. Another important element is adhering to a code of ethics and integrity.
These core elements can be realized through successful instruction, education, and guidance of compliant coding and documentation requirements.

Compliance Means Trust, Not Opinion

As a coding compliance professional, you should provide tangible information whenever you instruct another health care professional on appropriateness of coding or documentation. If established guidelines, specifications, and/or legislation cannot provide validation, than any guidance given is considered opinion. Protect trust at all cost. When an opinion is given as fact and later proven to be incorrect, this is unprofessional and risky. Once trust is broken, your opinion as a coding compliance professional is no longer credible. This guidance is simple; however, there are instances in the coding community where trust is destroyed.

Trust also is abused when a compliance professional tells a coder one thing and the health care provider something different. This behavior can stem from provider pressure or a provider’s inability to comply with rules and guidelines. To prevent inconsistent information from being disseminated, present the same guidelines, rules, and regulations to all parties involved. Using information consistently also shows ethics and integrity. To maintain consistency throughout an organization, consider following a code of ethics.

Code of Ethics

AAPC has a code of ethics which addresses coding professionalism and compliance integrity. The eight components of AAPC’s Code of Ethics are:

• Maintain and enhance the dignity, status, integrity, competence, and standards of our profession.
• Respect the privacy of others and honor confidentiality.
• Strive to achieve the highest quality, effectiveness, and dignity in both the process and products of professional work.
• Advance the profession through continued professional development and education by acquiring and maintaining professional competence.
• Know and respect existing federal, state, and local laws, regulations, certifications, and licensing requirements applicable to professional work.
• Use only legal and ethical principles that reflect the profession’s core values, and report activity that is perceived to violate this Code of Ethics to the AAPC Ethics Committee.
• Accurately represent the credential(s) earned and the status of AAPC membership.
• Avoid actions and circumstances that may appear to compromise good business judgment or create a conflict between personal and professional interests.

Other places to look for a code of ethics are your compliance or coding departments. Human Resource departments also may assist you if your company has a written code of ethics.

Use Compliance Tools at Your Fingertips

You can easily find useful tools to help you attain your goals. Here is a list of some typical resources you use:

• Office of Inspector General (OIG) website – On the “Compliance Guidelines” page, there are links to “Compliance 101 and Provider Education” and “Compliance Resource Material,” as well as other useful tools.
• Coding books –  CPT® codebook, CPT® Assistant, ICD-9-CM, HCPCS Level II, AHA Coding Clinic for ICD-9, AHA Coding Clinic for HCPCS, OptumInsight’s™ Uniform Billing Editor, DRG Expert, and the AAPC website
• Government coding/billing resources – Centers for Medicare & Medicaid Services (CMS) manuals; National Coverage Determinations; Medlearn Matters; the Federal Register; 1995 and 1997 Documentation Guidelines for Evaluation and Management Services; Medicare administrative contractors, Local Coverage Determinations, etc.
• Freedom of Information Act – Used to request federal agency records not publicly available.
• Federal acts –  Health Insurance Portability and Accountability Act (HIPAA); Health Information Technology for Economic and Clinical Health (HITECH) Act; the Affordable Care Act; Tax Relief and Health Care Act of 2006; False Claims Act; Medicare Prescription Drug, Improvement, and Modernization Act of 2003; Stark law; anti-kickback statute, etc.
• Commercial payer resources – Look to company manuals, websites, webinars, and newsletters for guidance.
• Company compliance manuals – Your employer should be anxious to share its compliance manuals and plans with coding and billing staff.

Being a coding compliance professional is a noble profession with ethics and integrity, knowledge of documentation and coding guidelines, and trust and validation at the core of its foundation. If you think you have what it takes to be a coding compliance professional or are thinking about becoming certified, AAPC now offers the Certified Professional Compliance Officer (CPCO™) credential. Go to aapc.com for details on how to begin this exciting journey.
Ida Landry, MBA, CPC, works for CareOregon and has worked in the health care industry since 1995. She acquired CPC® certification in 2004. Ms. Landry holds a Bachelor of Science in Health Administration and a Master of Business Administration in Health Care Management. She enjoys teaching and sharing her knowledge of coding.

Be an Effective Coding Compliance Professional: Do You Have What It Takes? was last modified: March 1st, 2013 by admin aapc