medical coder observing procedure

npricercm

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Would a medical coder who is observing a patient procedure in real time need a waiver from the patient in order to do so?

I would think this could be construed as a privacy issue since the coder is a non medical, non essential observer to the procedure.

I know if I was a patient and I found out that someone as non essential as a coder was present I would be upset if I didn't know they were a medical coder who just wanted to see the procedure beforehand.

Wouldn't this also have implications if for instance the procedure went bad and they discovered during an investigation that a non essential person was in the room and could have been a distraction to the doctor?

Has anyone has experience with this kind of thing?
 

mitchellde

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I don't know about legality with this but I do feel that the patient should be informed as to each person in the room and what their role is. As a patient I have questioned the role of people in the treatment room and I have requested non essential people be removed. The patient does have that right.
 

thomas7331

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Observing a procedure is a common practice and an essential part of teaching in the medical profession. If it's done for educational reasons I don't think there's anything wrong with it, though I imagine organizations would have policies like Debra mentions where the patient could be informed and have the right to opt out if they are not comfortable. There isn't a privacy issue - as long as the people involved are employed by the healthcare provider's organization the would fall under the umbrella of a HIPAA covered entity. I wouldn't expect being observed to be a distraction to a provider as they are always observed during their years of training and that alone should be nothing new. I imagine if an observer created a real distraction, a responsible provider would have that person removed from the room. I worked in a teaching hospital for four years and providers were always happy to have observers who sincerely wanted to learn. At the same time, if there was any potential for risk to the patient involved or possibility that an observer would get in the way, they would not hesitate to ask the non-essential people to leave the room.
 

npricercm

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Observing a procedure is a common practice and an essential part of teaching in the medical profession. If it's done for educational reasons I don't think there's anything wrong with it, though I imagine organizations would have policies like Debra mentions where the patient could be informed and have the right to opt out if they are not comfortable. There isn't a privacy issue - as long as the people involved are employed by the healthcare provider's organization the would fall under the umbrella of a HIPAA covered entity. I wouldn't expect being observed to be a distraction to a provider as they are always observed during their years of training and that alone should be nothing new. I imagine if an observer created a real distraction, a responsible provider would have that person removed from the room. I worked in a teaching hospital for four years and providers were always happy to have observers who sincerely wanted to learn. At the same time, if there was any potential for risk to the patient involved or possibility that an observer would get in the way, they would not hesitate to ask the non-essential people to leave the room.
A medical coder is not a the same as a resident or medical student a nurse or a PA. I'm not sure how a coder would fall under the HIPAA covered entity. Thank you.
 

mitchellde

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A medical coder is not a the same as a resident or medical student a nurse or a PA. I'm not sure how a coder would fall under the HIPAA covered entity. Thank you.
I have to agree. There is no way to justify that observation of a procedure is a necessary part of a coders job. Nor will it enhance the job performance. Idly curiousity is not protected.
 

npricercm

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What if the coder is an employee of the hospital?
Is it necessary for a coder, a non medical non essential person to observe a procedure to get their job done? There is a section under HIPAA that sates Limiting Uses and Disclosures to the Minimum Necessary. You can go to you tube and review surgeries and procedures.:) This would seem to be a legal issue.
 

thomas7331

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Of course if it's just for 'idle curiosity' or entertainment, that's not a valid reason. But as someone who has observed many procedures, I really have to disagree. It's a tremendous learning opportunity whether or not you're studying to become a practitioner. A better understanding of the nature of the work that is done in the healthcare profession is of great value to a coder's education, especially as coders are taking on so many different roles in this field.

As for the privacy implications and minimum necessary, I would always deferr to legal experts on this, but HHS does offer this guidance:

http://www.hhs.gov/hipaa/for-profes...ents-to-access-patient-information/index.html
 

npricercm

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Of course if it's just for 'idle curiosity' or entertainment, that's not a valid reason. But as someone who has observed many procedures, I really have to disagree. It's a tremendous learning opportunity whether or not you're studying to become a practitioner. A better understanding of the nature of the work that is done in the healthcare profession is of great value to a coder's education, especially as coders are taking on so many different roles in this field.

As for the privacy implications and minimum necessary, I would always deferr to legal experts on this, but HHS does offer this guidance:

http://www.hhs.gov/hipaa/for-profes...ents-to-access-patient-information/index.html
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The definition of “health care operations” in the Privacy Rule provides for “conducting training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers.” Covered entities can shape their policies and procedures for minimum necessary uses and disclosures to permit medical trainees access to patients’ medical information, including entire medical records.

This part if Hipaa discusses practitioners who want to improve their skills as health care providers or a practitioner. A coder is not a healthcare provider or practitioner improving their skills as a health care provider. Is there another section that reference administrative/billing staff?
 
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CodingKing

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Of course if it's just for 'idle curiosity' or entertainment, that's not a valid reason. But as someone who has observed many procedures, I really have to disagree. It's a tremendous learning opportunity whether or not you're studying to become a practitioner. A better understanding of the nature of the work that is done in the healthcare profession is of great value to a coder's education, especially as coders are taking on so many different roles in this field.

As for the privacy implications and minimum necessary, I would always deferr to legal experts on this, but HHS does offer this guidance:

http://www.hhs.gov/hipaa/for-profes...ents-to-access-patient-information/index.html
Especially when it comes to PCS where you almost need a medical degree to code correctly.
 

mitchellde

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If you have a medical coder that is properly and thoroughly educated in anatomy and physiology, and disease processes FIRST. ( like any medical student would be). Then if the coder feels that observing a procedure would better educate on procedure description and bundling issues... I might agree.
For an average medical coder to observe a procedure without proper background education, is idle curiosity. No matter how you see it though the patient has the final word and must be informed up front. Even in a teaching facility, we had a form that stated all the personnel that would be allowed into a given procedure room. The patient could go through this form and strike out any that they did not want to be there if the role was that of observer.
 
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CatchTheWind

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There was one statement made early in the thread that is not correct: "...as long as the people involved are employed by the healthcare provider's organization they would fall under the umbrella of a HIPAA covered entity." No! Employees are only allowed access to information that they need in order to do their job.

Since training is something they need in order to do their job, if the coder needs to observe the procedure in order to learn how to code it, then I would see this as being permitted. However, I find it hard to believe that observing a live surgery should be necessary in order to understand how to code it! If the coder is observing just because the providers want to give non-clinical staff an opportunity to see what they do, then HIPAA would not permit it unless the patient signs an authorization form. (And be careful, as HHS has very specific requirements for the verbiage that must be included on authorization forms.)
 

thomas7331

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I think some clarification is in order here as my original post, not very well worded, seems to have stirred up some unintended controversy. I'll repeat my disclaimer that I'm not an attorney or legal expert, but this is my understanding.

Accessing protected health information and observing a procedure are two different things. HIPAA provides for protection of PHI in the medical record which is defined as 'individually identifiable health information' that is 'transmitted or maintained' in the medical record. This is what is restricted to minimum necessary and it's been correctly pointed out that the access to PHI that is given to employees by an organization must be limited to what is required to do their job.

Observation of a procedure in and of itself is not accessing PHI and does not fall under the scope of the HIPAA law beyond incidental disclosure of elements of PHI that might occur during the course of the performance of that procedure. As the link I included points out, the HIPAA law does not penalize covered entities for this incidental disclosure if it occurs during the normal course of operations and if the entity has taken appropriate safeguards to protect and limit access to the PHI. This is what I meant in saying that employees of the organization "fall under the umbrella" of the HIPAA covered entity. I'm sure that as coders, almost every one us come into contact with more PHI than we really need to do our jobs because we are incidentally exposed to it in the regular course of our work. But as long as our organizations take steps to limit our access and to train us to handle it responsibly, they are not breaking the law.

All that said, I fully support and agree with what's been said about the rights of patients to have a say in who may participate in their care including who observes of a procedure. That is the right thing to do both from an ethical and a legal standpoint, and it's every healthcare organization's responsibility to set those policies to protect patients' privacy, as well as their own risks, appropriately. My original point was simply that I don't believe it's an automatic HIPAA violation if a coder watches a procedure.
 

CatchTheWind

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Thomas, I think your definition of PHI is too narrow. HHS defines PHI as "individually identifiable health information held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral," not just that which is "in the medical record." This opens HIPAA up even to observation of visits.
 

michelleaapc2012

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I have observed several procedures in the office and at the hospital. I had to sign a form and so did the patient. The provider actually took me to the patient rooms before surgery and I met the patients . It was very interesting and helped me with coding. I really appreciated the provider taking the time to show me and explain to me what was going on in the procedure. The patients were extremely nice and thought it was a good idea since I was the one billing their insurer. I never knew how many people were present in the operating room.
 
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