You are an auditor reviewing a spreadsheet that shows all of the records for the year in which the patient was on a mechanical ventilator. You are reviewing these records because, in every case, the coder has assigned a procedure code indicating that the patient was on mechanical ventilation for over 96 hours. When queried, the coder remarked that the hospital gets a higher reimbursement for that code than for a lower number of hours. You should:

Question

Quizplus · Accepted Answer

Assigning procedure codes for higher reimbursement without reflecting the actual service provided is unethical and potentially fraudulent. Discussing this issue with the Health Information Management Director is appropriate to address potential abuse or fraud.

You Are an Auditor Reviewing a Spreadsheet That Shows All