Unit VIII Case Study
Instructions
For this assignment, you will examine a scenario and apply sound ethical decision-making to determine the proper course of action.
Scenario:
Cindy Lou Kodingwho is a new coder at Southern Columbia Surgical Center. She works under the Office Manager, Martha May, but also closely works with the physicians directly when she needs documentation clarification.
Dr. Whobris is a physician at Southern Columbia Surgical Center. He sees a 12-year-old patient who has been previously seen for a right tibia fracture and casting at the Southern Columbia Surgical Center and is being seen again today for a new cast. Dr. Whobris indicates this cast should be billed separately from the previous visit.
Cindy Lou questions Dr. Whobris regarding the new cast and tells Dr. Whobris that she believes it should be bundled under the same surgical visit from the prior visit. Dr. Whobris insists this be coded as a new cast and separately from any prior service.
- What is the potential ethical dilemma CindyLou is facing?
- What are the facts of the situation?
- What may be CindyLou’s assumptions, biases, emotions, and values attached to this dilemma?
- Who are the stakeholders that are affected by this dilemma? What may be these stakeholder’s assumptions, biases, emotions and values attached to this dilemma?
- What are CindyLou’s options?
- What is the option(s) CindyLou should select? Justify the decision.
- How can this dilemma be prevented in the future?
- Why is it imperative that CindyLou follow all steps in this process? What benefit does it provide her professional growth and personal ethical decision-making skills?
- What is the final code(s) that CindyLou will apply?
Your case study should be a minimum of two pages. You must use at least one academically reliable source to support your analysis and decision-making. All sources used must be properly cited in APA style. APA formatting is otherwise not required.
Expert Solution Preview
Introduction:
As a medical professor in charge of creating assignments and evaluating student performance, it is essential to understand and apply sound ethical decision-making skills. In this case study, Cindy Lou Kodingwho, a new coder at Southern Columbia Surgical Center, faces an ethical dilemma, and we need to evaluate the situation to determine the proper course of action.
1. What is the potential ethical dilemma CindyLou is facing?
CindyLou’s potential ethical dilemma is the conflict of interest between billing accurately and advocating for the patient’s best interest. Dr. Whobris insists on billing the new cast separately, while CindyLou believes it should be bundled under the same surgical visit. If CindyLou were to comply with Dr. Whobris’s request, the patient could be charged more for the service, which could harm them financially.
2. What are the facts of the situation?
CindyLou works as a coder at Southern Columbia Surgical Center and works with the physicians directly when she needs documentation clarification. Dr. Whobris saw a 12-year-old patient who is being seen again for a new cast. Dr. Whobris suggests that this cast should be billed separately from the previous visit, but CindyLou believes that it should be bundled under the prior surgical visit.
3. What may be CindyLou’s assumptions, biases, emotions, and values attached to this dilemma?
CindyLou’s assumptions may be that Dr. Whobris’s request for a new cast could be an attempt to increase payment. Her biases could include that physicians are only interested in billing as much as possible to increase their income. Emotions attached to this dilemma could include frustration, given Dr. Whobris’s adamant request and the potential harm to a patient. Her values may be that accuracy and advocating for patients’ best interests are of utmost importance.
4. Who are the stakeholders that are affected by this dilemma? What may be these stakeholder’s assumptions, biases, emotions, and values attached to this dilemma?
Stakeholders that are affected by this dilemma include the patient, the surgeons, and the coders. The patient could be affected by the increased charges that Dr. Whobris’s request for a new cast could incur. The surgeon may believe that billing for a new cast is the ethical and accurate thing to do. The coder could feel pressure to comply with the physician’s request and may want to avoid conflict. The stakeholders’ assumptions, biases, emotions, and values can vary depending on their role in the surgical center.
5. What are CindyLou’s options?
CindyLou’s options include billing for the new cast separately, verifying if the new cast is a separate charge, or informing her supervisor of the situation.
6. What is the option(s) CindyLou should select? Justify the decision.
CindyLou should verify if the new cast is a separate charge and inform her supervisor of the situation. This option ensures accuracy in billing and advocacy for the patient’s best interest. Her supervisor can then evaluate the situation and determine the best course of action.
7. How can this dilemma be prevented in the future?
To prevent this dilemma in the future, clear communication and documentation between the surgeon and the coder are essential. The surgical center can provide training on ethical decision-making skills to promote accuracy in billing and advocating for the patient’s best interest.
8. Why is it imperative that CindyLou follows all steps in this process? What benefit does it provide her professional growth and personal ethical decision-making skills?
It is imperative that CindyLou follows all steps in this process to promote accuracy in billing, advocacy for the patient’s best interest, and ethical decision-making. Following these steps provides CindyLou with growth in her professional skills and personal ethical decision-making skills.
9. What is the final code(s) that CindyLou will apply?
The final code that CindyLou will apply depends on verifying if the new cast is a separate charge. If it is a separate charge, then CindyLou will apply the new code. If it is not, the cast will be bundled under the prior surgical visit.
