Explain why it is important to know the differences between the code sets when submitting electronic claims?

The use of code sets is used to conceal sensitive information such that only professionals are able to decipher the information being transmitted. Hence, failure to understand the different code representation could lead to erroneous interpretation.

According to the Health Insurance Portability and Accountability Act, which is a federal law geared towards the protection of patient's health information. Sensitive health information must be duly protected and preserved. Hence, the use of codes in submitting electronic claims.

Therefore, the need to understand the different code sets is vital towards correct interpretation and understanding of patient's claim.

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It is important that the medical coder puts in the correct code when submitting claims. It is important because the codes show what the patient is seen for and what the doctor does during the procedure or office visit. If the coder puts in the wrong code set, the patient could be misdiagnosed to their insurer or charged unfairly. Each visit, procedure, lab test, etc has their own code set to abide by. The coder should have software that enables them to check over their codes before the final submission.

During the process of submitting electronic claims, HIPPA law must followed and the patients privacy should always be kept as the number one priority.

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