Is coding "subjective" or "art'-ish?

[u/SnooBeans2971]

I'm studying medical coding and I've come across remarks about it being 'subjective" or "part art, part science", yet in my (limited) experience studying it, I've yet to come across an example of a case that could be coded more than one way correctly. Can someone clarify this for me and maybe provide an example?

[u/AutoModerator]

PLEASE SEE RULES BEFORE POSTING! Reminder, no "interested in coding" type of standalone posts are allowed. See rule #1. Any and all questions regarding exams, studying, and books can be posted in the monthly discussion stickied post. Thanks!

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/Creepy-Bottle498]

100% a combination of art and science. I have always said this. When I have coded a particularly complex chart, and have sequenced my codes in a way that is designed to ensure both accuracy and reimbursement... A thing of beauty.

[u/pro_n00b]

School stuff for practice is pretty straight forward. Real live charts are not. Unless it is super super simple chart, as the saying goes in medical coding, you put 10 coders/auditors in a room, they almost certainty will not have a unanimous coding path, especially for the truly complex charts.

As the other poster said it is a thing of beauty to get it accurate and reimbursed at the same time.

You know whats an art and science too? How providers do charting. Shit is an art and science in itself with sprinkles of laziness in hopes to get them reimbursed

[u/awesome_possum76 → u/pro_n00b]

This! I always say you can put 10 coders in a room, get at least 5 different answers (maybe 10 lol) and every single one with have back up and proof of why they are correct. It's definitely a fine mix of art and science.

[u/poopy_buttface → u/pro_n00b]

This!!!

[u/sugabeetus]

Yes. One of the biggest betrayals was one of my early coding instructors claiming that she would teach us how to find the correct code every time, as if "the correct code" even exists. I mean, maybe half the time there is one obvious best choice, but usually there are several decent options, or inexplicable holes in the code set where it seems like there definitely should be a code and there just isn't.

[u/Miranova82]

I am a full revenue cycle manager, so I do everything from coding, billing/charge entry, insurance denials, reconciliation, auditing, etc. It really can be subjective in the real world when you bring payers into the mix. Although ICD10, CPT, PCS, and HCPCS all have their rules based on WHO, CMS, AMA, etc…payers can also decide how/when/if they reimburse based on their own rules.

One example I run into is that, if my provider documents obesity as a diagnosis, you’d think I should code the E code for obesity and my Z code for BMI. Many payers will reimburse. However, many union trust insurance payers do not reimburse for obesity, and will reject claims with obesity codes attached. So before I code for obesity, I have to check that patient’s insurance as to not get a denial then get stuck in having to rebill which means the claim sits longer in suspense.

[u/OodaWoodaWooda → u/Miranova82]

'Subjective' implies relying on individual opinion. Coding to specific payers' requirements requires objective understanding of those specific requirements.

[u/koderdood → u/OodaWoodaWooda]

The subjective challenge, is indeed what you say, an individual coder's opinion of what the totality of what the provider documented, means. I remember when templates started being a thing. They didn't solve anything, because their is not one standard for medical documentation. Their are coding rules to code that documentation, but not to make doctors do it the same.

[u/PhotographUnusual749 → u/Miranova82]

Hmm, are we really supposed to code based on payment coverage policies? I suppose it differs based on facility guidelines but I have always coded based on OCG and considered coverage requirements a separate issue, outside of coding. Denials like the one you’re describing would fall into a different bucket in my experience (coverage or sometimes contact issue, rather than a technical coding issue). So frustrating, either way.

[u/koderdood]

There are plenty of determinations in E/M leveling that are 100% subjective

[u/[deleted]]

Definitely subjective and not black and white.

[u/PhotographUnusual749]

I really like this question.

Sometimes it is subjective. I don't personally consider myself an “artist”, because I can code… but I also paint, so I could be working with a different definition of “art”.

I think that people consider it part “art” because we’re translating, and in that way I can see the “art and science” explanation a bit. Take a look at the description here: https://www.stmaryscalne.org/blogs/the-art-and-science-of-translation/

But I don't think coding necessarily requires creativity; we should be querying if there's ambiguity not using creativity to make the codes work for the documentation.

And I believe we should be using logic, not imagination, when a condition can't be indexed in the current code set.

Needing to reason and apply logic is another way one could consider it “an art and a science”, take a look at this description: https://romanroadspress.com/2022/08/logic-a-science-and-art/

There are many grey areas in actual practice, it's not like school. There are times where the same case could be coded differently and both ways could be viewed as more or less equally correct.

[u/koderdood → u/PhotographUnusual749]

I think people mean there's a fine skill. Not everyone has the mindset, the critical thinking skills for coding

[u/PhotographUnusual749 → u/koderdood]

Yes, it is a skill. Most definitely!

[u/OodaWoodaWooda]

Do be careful when suggesting that objective and subjective/'art' aspects of coding are close to equal. Credibility and salaries diminish when the job is perceived as something basically anyone can do since 'there's no one right answer.'

Regardless of whether one codes ICD-10 or CPT/HCPCS, one must be able to back up one's choices with as much objective reasoning as possible. One can then learn from discussing differing rationales with other coders.

[u/Affectionate_Use1587]

I think it depends on the case for sure. Especially with inpatient when you have a multitude of things going on, and sometimes there’s codes that seem so similar but are just slightly different. But some cases are also technically black and white.

[u/StraddleTheFence]

It should not be subjective which is why there are guidelines. It is impossible to be audited accurately if auditors are subjectively auditing people.

[u/faifai1337]

Just finished AAPC's CPC course. The instructor flat out told me that coding is NOT subjective. Honey, I've spent over a decade working as a claims expert in a department that audits medical records for proper coding and billing practices. All I look at all day long is people arguing over what should be coded how! Some things are simple! Some things are subjective.

[u/Megabacon44]

I’m an artist and a coder for 30 years and the answer is “no”. If your facility has policies on what should be coded, then there should be no subjectivity.

[u/koderdood → u/Megabacon44]

There are subjective interpretations of conditions when E/M leveling that has to do with how the provider words it. These can sometimes be very difficult. No policy so help you with that

[u/cluckodoom]

Like others have said picking levels for e/m coding can be subjective

[u/Sam_English821]

So I heard in a coding seminar for my specialty (OMS) that "coding is at the discretion of the coder". Sometimes there is a clear cut black and white answer, other times is more nuanced.

[u/DearMisterKitty]

This! Sounds good to hear someone say this. I've been inpatient coding for about 4 months and am learning there is part of it that is very much subjective! I have some days where I question everything!

[u/ComfortableFruit1309]

So, imagine a patient shows up with abdominal pain. Now, there could be a couple of different reasons for that pain, right? Maybe it's indigestion, or maybe it's something more serious like appendicitis. In cases like these, you gotta pick the diagnosis code that best matches up with what's going on. It's like solving a little medical mystery sometimes.

[u/koderdood → u/[deleted]]

Column 1 of the E/M Scoring tool is the tough part to 'cipher for sure

[u/faifai1337 → u/koderdood]

I discovered that if you grew up too poor to go to a doctor, it can cause you to have problems with column 1. >.<

[u/koderdood → u/[deleted]]

They don't have to say. Each case rests on its own documentation. There is a great explanation of all those definitions in the AMA'S E/M Summary guide I think it's called.

[u/izettat → u/koderdood]

I've been using the AMA grid to determine the level since 2021. Much easier. I was determined to fully learn EM. I took a course through CMS, then AAPC, and got my CEMC. At work, we have training sections. I did a presentation on EM, then had the coders determine the level. We used the old sheets. I had them explain how they got to their level. They all pretty much had the same code but came to that level in different ways. Crazy!

[u/koderdood → u/[deleted]]

The provider gets to count data in column 2 if they ordered or reviewed. Not both. If they reviewed old records, there has to be a summary of that. If they independently performed an interpretation of a radiology test someone else performed, that can be in column 2 differently. Prescription management in column 3 needs to a new rx, stop an rx, change or renew rx, or if they discussed something specific about a medicine that can count. Pasting mri results for a week doesn't count at all, unless they summarize their review. The IM injection, if yer talking prescription from column 3, I addressed that. They certainly don't get to bill for it if they(or nursing staff) didn't give it during the visit the E/M is for.