Standards for Ethical Coding in Medical Practice

Introduction

When it comes to medical coding, ethical and moral questions may not seem like a significant concern — but that is most certainly not the case. Issues like moral distress and conscientious objection are not hard to find in the media or in professional literature. The recent controversy regarding private religious organizations being required to cover birth control is proof of that. This paper covers two distinct articles on the subject and examines how each assesses the standards of ethical coding.

Stegman on Coding Standards and Best Practices

The first article, authored by Stegman (2008), addresses how certain codes and qualifiers used when coding medical procedures can lead to ethical quandaries. The article advocates for all professionals adhering to ICD-9-CM conventions and stridently asserts that all coding must be based solely and completely on the notes of the treating physician. The article also strongly advocates for coders remaining completely up to date on ethical standards and their overall skill set, lest they develop bad habits that run afoul of best practices or ethical guidelines.

There are a few points worth critiquing in this article. First, not all physicians are acting in full compliance, and others are exceedingly sloppy in making exhaustive or legible notes. Coders can strive for excellence, but that effort is undermined when the physicians themselves are the source of the problem. Second, Stegman's point about remaining current with procedures and technology is well-taken. Far too many professionals coast in their roles, and anyone unwilling to maintain their competency is not suited for a medical career of any sort involving cost structures or patient care. Healthcare costs are rising for reasons that have nothing to do with medical coding per se, but there is surely a substantial amount of waste and inefficiency occurring as well.

Davis on Moral Distress and Conscientious Objection

The Davis (2012) article addresses a prominent and consequential topic: the dual issue of moral distress and conscientious objection, and their effect on the medical coding sphere. For example, a nurse or physician may encounter a patient near death due to pregnancy complications, where the only way to save the mother is to terminate the pregnancy. That may be the medically indicated course of action, yet many doctors and nurses would refuse to involve themselves in such a procedure — even when there is a compelling medical rationale that has nothing to do with elective use of birth control.

The article notes that, according to 75% of survey respondents, the moral standing and wishes of the patient should always take precedence over those of the medical professional. Conflicts in this area are most commonly attributed to religious convictions. This is further complicated by the fact that freedom of religion is protected under the First Amendment, yet many argue that this right must yield in matters of life and death, or in the medical field more broadly. Medical coding is directly affected by these dynamics because coding can be manipulated in highly unethical ways based on the moral positions of the coders themselves or the physicians whose notes drive that coding.

Conclusion

As long as religion and other sources of moral objection are present, the questions raised by the Davis article will always be an issue. Similarly, until there is industry-wide enforcement against sloppy or lazy practice, there will be massive amounts of inefficiency. People will make excuses, and institutional resistance will arise around complaints of due process. However, in either case, professionals who are unwilling or unable to set aside personal beliefs when their role demands impartiality should not be in a field that requires them to choose between their morality and their responsibilities — and those who are unwilling to apply themselves fully should not be providing or supporting life-giving care.