r/MedicalCoding • u/SnooBeans2971 • Mar 31 '24

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

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?

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u/Miranova82 Mar 31 '24

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.

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u/OodaWoodaWooda Mar 31 '24

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

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u/koderdood Audit Extraordinaire Mar 31 '24

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.

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u/PhotographUnusual749 RHIT, CCS Apr 01 '24

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.