It is the coder's responsibility to assign codes completely and accurately so that a facility receives the reimbursement to which it is entitled. To meet this responsibility, a coder must:

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The coder must use their knowledge and skills to accurately assign codes based on the documentation in the medical record. The use of software is meant to assist the process and should not be relied upon completely. It is important to code and sequence based on the documentation to ensure accurate reimbursement for the facility. Following software prompts blindly or sequencing for the highest reimbursement can lead to inaccurate coding and potential legal and financial issues.

It Is the Coder's Responsibility to Assign Codes Completely and Accurately