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The basic task of a clinical coder is to classify medical and health care concepts using a standardised classification. Inpatient, mortality events, outpatient episodes, general practitioner visits and population health studies can all be coded. Clinical coding has three key phases: a) abstraction; b) assignment; and c) review. [5]
Code review (sometimes referred to as peer review) is a software quality assurance activity in which one or more people examine the source code of a computer program, either after implementation or during the development process. The persons performing the checking, excluding the author, are called "reviewers".
The World Health Organization (WHO) stated that the proper collection, management and use of information within healthcare systems "will determine the system's effectiveness in detecting health problems, defining priorities, identifying innovative solutions and allocating resources to improve health outcomes".
A software development methodology is a framework that is used to structure, plan, and control the life cycle of a software product. Common methodologies include waterfall, prototyping, iterative and incremental development, spiral development, agile software development, rapid application development, and extreme programming.
These diagnosis and procedure codes are used by health care providers, government health programs, private health insurance companies, workers' compensation carriers, software developers, and others for a variety of applications in medicine, public health and medical informatics, including: statistical analysis of diseases and therapeutic actions
Level III codes, also called local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructed CMS to adopt a standard coding systems for reporting medical transactions.
[2] [3] With automation, software tools provide assistance with the code review and inspection process. The review program or tool typically displays a list of warnings (violations of programming standards). A review program can also provide an automated or a programmer-assisted way to correct the issues found.
The CCC provides a unique framework and coding structure. Used for documenting the plan of care; following the nursing process in all health care settings. [1] The Clinical Care Classification (CCC), previously the Home Health Care Classification (HHCC), was originally created to document nursing care in home health and ambulatory care settings ...