‘Sailing the Seven Cs’ with the Clinical Coders' Creed. The Eighth ‘C’: Private Sector Coding

Abstract

This article briefly relates the experience of a clinical coder working in the private healthcare sector in the Australian state of New South Wales and questions whether it is possible to work in this environment while adhering to the Clinical Coders‘ Creed. Private facilities in Australia that handle acute, psychiatric, respite and rehabilitation cases, rely mainly upon health insurance funds for reimbursement for episodes of care, which are funded according to DRGs based on codes assigned by clinical coders. The point is made that while all coders strive to fully and accurately describe the clinical episode of care regardless of healthcare setting, a distinction can be drawn between public and private sector coding in relation to financial contracts, which form the basis of private health care. Therefore, it is recommended that private sector coders familiarise themselves with this “C” as well as the other seven “Cs” of the Clinical Coders’ Creed.

Keywords

ICD-10-AM Clinical Coding Australia Private Sector

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References

National Centre for Classification in Health (1998). From the desk of the Director. Coding Matters (5)1: July.

National Centre for Classification in Health (2008). The International Statistical Classification of Diseases and Related Health Problems, Australian Modification, Sixth Edition. Available at: http://nis-web.fhs.usyd.edu.au/ncch_new/2.aspx (accessed 9 December 2008).