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Real-World Case 21.2 Kelly was a new coder who had never held an HIM job before. She had just graduated from college and...

Real-World Case 21.2 Kelly was a new coder who had never held an HIM job before. She had just graduated from college and passed her RHIT when she was hired by a local clinic and was so excited to start working. A few weeks later, her manager asked to meet with her. The manager closed the door and told Kelly that she wanted her to code charts for a particular procedure using two codes instead of one so the reimbursement would be higher. The manager then proceeded to divulge information that the clinic was struggling financially so anything extra would help. Kelly got the impression that if she did not comply they would let her go; and she really needed this job. Also, since it was her boss asking, she felt obligated to do as she was told.

Real-World Case Discussion Questions Read RW 21.2 question 1 & 2

1. What are the ethical issues associated with this case?

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Answer #1

According to the given situation the manager was asked Kelly to code charts for a particular procedure using two codes instead of one, it is completely unethical and clearly fraudulent. In this situation the manager was clearly know it was wrong. Unbundling codes or upcoding for higher reimbursement is a serious no-no.

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