The investigation demonstrates a common challenge in rheumatology practices: ensuring accurate and compliant reporting of services rendered, particularly when dealing with complex diagnoses and evolving payer requirements. The professional challenge lies in balancing efficient workflow with the meticulous adherence to coding guidelines and payer policies to prevent claim denials, audits, and potential financial penalties. Careful judgment is required to interpret clinical documentation, apply appropriate CPT and ICD-10-CM codes, and understand the specific reporting nuances for rheumatological conditions. The best professional practice involves a systematic review of all clinical documentation against established coding guidelines and payer-specific policies before claim submission. This approach prioritizes accuracy and compliance by ensuring that all reported services are supported by the medical record and meet the criteria for reimbursement. Specifically, this entails verifying that the diagnosis codes accurately reflect the patient’s condition as documented by the physician, and that the procedure codes accurately represent the services performed. Furthermore, it includes confirming that any required modifiers are correctly appended and that all necessary supporting documentation is readily available for potential audits. This proactive verification process minimizes the risk of errors and aligns with the ethical obligation to report services truthfully and accurately. An incorrect approach would be to rely solely on historical billing patterns or the physician’s initial coding suggestions without independent verification. This method is prone to errors, as it does not account for changes in coding guidelines, payer policies, or specific patient documentation nuances. It fails to uphold the professional responsibility to ensure coding accuracy and can lead to significant compliance issues. Another incorrect approach is to submit claims with minimal documentation review, assuming that the electronic health record system will automatically flag any obvious errors. While EHRs can assist, they are not a substitute for human oversight and understanding of complex coding rules. This approach risks overlooking subtle but critical coding errors, such as incorrect sequencing of diagnoses or the omission of necessary modifiers, which can result in claim rejections or recoupments. A further incorrect approach is to prioritize speed of claim submission over accuracy, particularly during peak periods. While efficiency is important, it should never compromise the integrity of the coding and billing process. Submitting claims without thorough review, even if done quickly, can lead to a higher volume of denied claims and subsequent rework, ultimately hindering overall practice efficiency and financial health. Professionals should adopt a decision-making framework that emphasizes a thorough, multi-step review process. This includes: 1) understanding the patient’s clinical encounter through comprehensive review of physician notes, test results, and other relevant documentation; 2) accurately translating the clinical information into appropriate ICD-10-CM diagnosis codes; 3) selecting the correct CPT codes for procedures and services rendered, ensuring they are supported by the documentation; 4) applying any necessary modifiers according to established guidelines; and 5) verifying compliance with specific payer policies and guidelines before final claim submission. This systematic approach fosters accuracy, minimizes risk, and ensures ethical and compliant reporting.

Scenario Analysis: This scenario is professionally challenging because it requires a coder to accurately translate complex medical terminology into billable codes, directly impacting patient care documentation and reimbursement. Misinterpreting rheumatological terms can lead to incorrect coding, potentially causing claim denials, audit issues, and inaccurate representation of the services provided. The pressure to be efficient must be balanced with the absolute necessity for precision in medical coding. Correct Approach Analysis: The best professional practice involves meticulously reviewing the physician’s documentation, cross-referencing unfamiliar or ambiguous rheumatological terms with authoritative medical dictionaries and coding resources, and seeking clarification from the physician when necessary. This approach ensures that the coder possesses a comprehensive understanding of the clinical context before assigning codes. Specifically, understanding terms like “arthralgia” (joint pain) versus “arthritis” (inflammation of a joint) is crucial. “Arthralgia” is a symptom, while “arthritis” is a diagnosis. Coding “arthritis” when only “arthralgia” is documented would be an overstatement of the condition and a coding error. This meticulousness is ethically mandated to ensure accurate representation of patient conditions and legally required to comply with coding guidelines that demand documentation support for all assigned codes. Incorrect Approaches Analysis: One incorrect approach is to assume the meaning of a term based on its common usage outside of a medical context. For example, interpreting “fibromyalgia” solely as “muscle pain” without understanding its specific diagnostic criteria and associated symptoms as defined in rheumatology literature would lead to miscoding. This fails to adhere to the principle that medical terminology must be interpreted within its precise clinical and diagnostic framework. Another incorrect approach is to rely solely on the most frequently used code for a particular organ system without fully understanding the specific condition described. For instance, if a physician documents “rheumatoid factor positive,” a coder might be tempted to assign a general code for autoimmune disease. However, this overlooks the need to identify the specific rheumatological condition being investigated or treated, such as rheumatoid arthritis, which has distinct ICD-10-CM codes. This approach neglects the specificity required by coding guidelines. A further incorrect approach is to proceed with coding without seeking clarification when the documentation is vague or uses non-standard terminology. If a physician notes “joint stiffness,” a coder might assign a code for stiffness without determining if it’s related to a specific underlying condition like osteoarthritis or ankylosing spondylitis, which would require more specific coding. This bypasses the ethical obligation to ensure accurate and complete coding based on supported documentation. Professional Reasoning: Professionals should adopt a systematic process that prioritizes understanding over speed. This involves a thorough review of the medical record, active engagement with coding resources to define and contextualize terminology, and a commitment to seeking physician clarification for any ambiguity. This layered approach ensures that coding decisions are not only compliant but also ethically sound, reflecting the true clinical picture of the patient.

Scenario Analysis: This scenario presents a professional challenge due to the potential for miscoding a common rheumatologic condition, leading to inaccurate patient records, improper billing, and potentially affecting future treatment decisions or research. The complexity arises from the overlapping symptoms of various inflammatory arthropathies and the need for precise documentation to support the chosen diagnosis code. Careful judgment is required to ensure the code accurately reflects the physician’s documented findings and the patient’s clinical presentation. Correct Approach Analysis: The best professional practice involves a thorough review of the physician’s complete medical record, including the history of present illness, physical examination findings, diagnostic test results (e.g., laboratory work, imaging), and the physician’s final assessment and plan. This comprehensive approach ensures that the selected ICD-10-CM code for rheumatoid arthritis (RA) is supported by objective evidence and aligns with the established diagnostic criteria for RA, such as those from the American College of Rheumatology (ACR). Specifically, the documentation must support the presence of inflammatory arthritis affecting multiple joints, characteristic serological findings (e.g., rheumatoid factor, anti-CCP antibodies), and the duration of symptoms. This meticulous review process is ethically mandated to ensure accurate representation of patient care and compliance with coding guidelines. Incorrect Approaches Analysis: One incorrect approach involves coding based solely on the physician’s initial impression or a single symptom mentioned in the progress note, without cross-referencing other parts of the record. This fails to account for the full clinical picture and may lead to coding a condition that is not definitively diagnosed or is a differential diagnosis. This is a failure of due diligence and can result in inaccurate coding, violating principles of accurate medical record representation. Another incorrect approach is to code based on the patient’s self-reported symptoms or a previous diagnosis from a different provider without current physician documentation to support it. While patient history is important, the coder’s responsibility is to code based on the current physician’s documented findings and assessment for the encounter. Relying on external or past information without current validation is a deviation from standard coding practice and can lead to misrepresentation of the current medical encounter. A further incorrect approach is to assume the diagnosis of rheumatoid arthritis based on the specialty of the physician (rheumatologist) and the commonality of the condition within that specialty. Coding must always be based on specific documentation within the patient’s chart for the encounter, not on assumptions or generalizations about a specialty. This approach bypasses the essential step of verifying the diagnosis through documented clinical evidence, which is a fundamental ethical and professional requirement for coders. Professional Reasoning: Professionals should employ a systematic decision-making framework that prioritizes comprehensive documentation review. This involves: 1) Identifying the chief complaint and relevant history. 2) Analyzing physical examination findings for objective signs of inflammation and joint involvement. 3) Correlating laboratory and imaging results with clinical findings. 4) Carefully examining the physician’s assessment and plan for the definitive diagnosis and any supporting rationale. 5) Consulting official coding guidelines and resources to select the most specific and accurate ICD-10-CM code that is fully supported by the documented evidence. This structured approach ensures accuracy, compliance, and ethical practice.

Scenario Analysis: This scenario is professionally challenging because it requires the coder to navigate the nuances of documentation interpretation and the specific coding guidelines for rheumatological conditions, particularly when a definitive diagnosis is pending. The physician’s note indicates suspicion of a condition but lacks a confirmed diagnosis, creating ambiguity that directly impacts accurate coding and subsequent reimbursement. Careful judgment is required to ensure compliance with coding standards and ethical reporting practices without overstating or understating the patient’s condition. Correct Approach Analysis: The best professional practice involves accurately reflecting the documentation as it stands, even if it indicates a suspected condition. This means coding for the signs and symptoms that led to the physician’s suspicion, as these are documented and supported by the encounter. This approach aligns with the principle of coding based on documented evidence and avoids speculative coding. It ensures that the claim accurately represents the services provided and the patient’s presentation at the time of the encounter, adhering to the fundamental rule of coding what is documented. Incorrect Approaches Analysis: Coding for a definitive diagnosis that is only suspected by the physician is a significant ethical and regulatory failure. This constitutes speculative coding, which can lead to fraudulent claims and misrepresentation of patient care. It violates the principle of coding based on confirmed diagnoses and documented findings. Similarly, coding only for the signs and symptoms without acknowledging the physician’s diagnostic suspicion, when that suspicion is documented, fails to capture the full clinical picture presented in the encounter notes. This can lead to underreporting of the complexity of the patient’s condition and potentially impact future care planning or research data. Coding for a condition that is not even suspected, based on a vague symptom, is entirely unsupported by the documentation and represents a clear violation of coding standards and ethical practice. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes accurate representation of documented clinical information. This involves thoroughly reviewing the physician’s documentation, identifying all documented signs, symptoms, and any stated diagnostic impressions or suspicions. When a definitive diagnosis is absent but a suspected condition is noted, the coder should code for the documented signs and symptoms that support the suspicion, and if appropriate, use a code that reflects an “unspecified” or “suspected” condition if such a code exists and is supported by the documentation and payer guidelines. The coder must always avoid coding for conditions not explicitly documented or strongly implied by the physician’s assessment.

Scenario Analysis: This scenario is professionally challenging because it requires the coder to interpret complex anatomical and physiological information within the context of specific rheumatological conditions and their documented manifestations. Misinterpreting the underlying pathology or the relationship between anatomical structures and disease processes can lead to incorrect coding, impacting patient care documentation, billing accuracy, and potentially research data. The challenge lies in moving beyond simple identification of terms to understanding their clinical significance in a rheumatological context. Correct Approach Analysis: The best professional practice involves a comprehensive review of the patient’s medical record, focusing on the rheumatologist’s documented findings related to joint inflammation, synovial membrane involvement, and the impact on musculoskeletal structures. This approach prioritizes understanding the specific pathological processes described by the physician, such as synovitis, tenosynovitis, or bursitis, and how they relate to the affected anatomical sites. By correlating the documented pathology with the specific anatomical locations and the described physiological effects (e.g., pain, swelling, limited range of motion), the coder can accurately identify the most appropriate diagnostic and procedural codes. This aligns with the ethical obligation to ensure accurate representation of patient conditions and the professional responsibility to maintain coding integrity. Incorrect Approaches Analysis: One incorrect approach would be to solely focus on identifying keywords related to joints and pain without understanding the specific rheumatological condition or the documented pathological process. This fails to capture the nuances of rheumatological diagnoses and can lead to oversimplification or miscoding of the severity and nature of the condition. It neglects the critical step of understanding the underlying pathology, which is central to accurate rheumatological coding. Another incorrect approach would be to assume a diagnosis based on common rheumatological presentations without explicit documentation of the specific anatomical structures affected by inflammation or degeneration. Rheumatological conditions can manifest in various ways and affect different joints or tissues. Relying on assumptions bypasses the physician’s documented findings and introduces a significant risk of coding errors, violating the principle of coding based on documented evidence. A further incorrect approach would be to code based on the patient’s reported symptoms alone, without correlating them with the physician’s diagnostic assessment and anatomical findings. While symptoms are important, they are subjective and require physician interpretation and confirmation through examination and diagnostic workup. Coding solely on symptoms without the physician’s documented diagnosis and anatomical correlation is a deviation from accurate coding practices. Professional Reasoning: Professionals should approach this scenario by first understanding the core question: how to accurately code rheumatological conditions based on anatomical and physiological understanding. The decision-making process should involve a systematic review of the medical record, prioritizing the physician’s documented diagnosis and findings. This includes identifying the specific anatomical structures involved, the nature of the pathological process (inflammation, degeneration, etc.), and the physiological impact. The coder must then translate this documented clinical picture into the appropriate ICD-10-CM and CPT codes, ensuring that the chosen codes accurately reflect the documented condition and its anatomical and physiological basis. This systematic approach, grounded in the physician’s documentation, ensures coding accuracy and ethical compliance.

Scenario Analysis: This scenario presents a common challenge in rheumatology coding: accurately capturing the complexity of an established patient visit when multiple issues are addressed, but not all require significant work. The professional challenge lies in distinguishing between a brief mention of a chronic condition and a condition that necessitates a distinct evaluation and management service, thereby impacting the appropriate E/M level. Misinterpreting the physician’s documentation can lead to undercoding or overcoding, both of which have significant compliance and financial implications. Careful judgment is required to interpret the physician’s documented work and align it with the established E/M guidelines. Correct Approach Analysis: The best professional practice involves a thorough review of the entire medical record to determine the level of medical decision-making (MDM) or time spent. This includes scrutinizing the physician’s documentation for each identified problem. If a chronic condition, like osteoarthritis, is mentioned but the physician’s documentation indicates it is stable and requires no further workup or management during this encounter, it should not be counted as a distinct problem requiring MDM. Conversely, if the physician documents a review of systems, examination findings, or ordering of tests related to that chronic condition, it would contribute to the MDM. The focus must be on the work performed by the physician for each identified problem, not merely the existence of the problem. This aligns with the principles of E/M coding which emphasize the physician’s cognitive effort and time dedicated to patient care. Incorrect Approaches Analysis: One incorrect approach is to assign the highest E/M level based solely on the number of diagnoses listed in the problem list, regardless of the physician’s documented work for each. This fails to adhere to the E/M guidelines, which require assessment and management of each identified problem to contribute to the MDM. Simply listing a stable chronic condition without any documented evaluation or management does not warrant credit towards the E/M level. Another incorrect approach is to assign an E/M level based on the physician’s subjective statement that multiple issues were discussed, without independently verifying the depth of the physician’s documented work for each issue. E/M coding relies on objective documentation of the physician’s actions and thought processes, not just a general statement of discussion. A further incorrect approach is to assign an E/M level based on the patient’s chief complaint alone, ignoring other documented issues that may have been evaluated and managed during the encounter. While the chief complaint is important, the E/M level should reflect the totality of the physician’s work for all addressed problems. Professional Reasoning: Professionals should approach E/M coding by first identifying all the problems addressed by the physician during the encounter, as documented in the medical record. Then, for each problem, they must assess the physician’s documented work, including history, examination, and medical decision-making. The E/M level should be determined by the highest level of MDM or the total time spent, considering the complexity and management of each problem that required physician work. This systematic approach ensures accurate coding and compliance with established guidelines.

Scenario Analysis: This scenario presents a common challenge in rheumatology coding where a patient presents with multiple, potentially related, chronic conditions. The professional challenge lies in accurately reflecting the full scope of the patient’s illness and the services provided without over-coding or under-coding, which can impact reimbursement, quality metrics, and patient care documentation. Careful judgment is required to discern the principal diagnosis and any co-existing conditions that warrant separate coding and reporting. Correct Approach Analysis: The best professional practice involves identifying the primary reason for the encounter and then coding all documented co-existing conditions that affect patient care, treatment, or management. This approach ensures that the patient’s complete clinical picture is captured, supporting appropriate medical necessity and reimbursement. Specifically, it requires reviewing the physician’s documentation to determine the principal diagnosis and then appending ICD-10-CM codes for all other conditions that are treated, evaluated, or monitored during the encounter. This aligns with the fundamental principles of accurate medical coding, which mandate reflecting all conditions that influence patient care. Incorrect Approaches Analysis: One incorrect approach is to only code the most severe condition identified, neglecting other documented diagnoses that impact the patient’s care. This fails to provide a comprehensive picture of the patient’s health status and can lead to under-documentation of the complexity of care, potentially affecting quality reporting and reimbursement. Another incorrect approach is to code every condition mentioned in the patient’s history, regardless of whether it is actively managed or impacts the current encounter. This practice constitutes over-coding and can lead to inaccurate data, inflated billing, and potential compliance issues. Medical necessity must be demonstrated for each coded condition. A further incorrect approach is to code only the symptoms presented, without identifying the underlying diagnoses. While symptoms are important, ICD-10-CM guidelines emphasize coding to the highest level of specificity, which typically means coding the established diagnosis rather than just the manifestations. This can lead to incomplete documentation and hinder appropriate care management. Professional Reasoning: Professionals should approach this situation by first thoroughly reviewing the physician’s documentation. They should identify the principal diagnosis as stated or implied by the physician’s assessment and plan. Subsequently, they must identify all other documented conditions that were evaluated, treated, or managed during the encounter. This systematic process ensures that coding is both compliant with ICD-10-CM guidelines and accurately reflects the patient’s clinical status and the services rendered. When in doubt, consulting the physician for clarification on the relationship between diagnoses or the impact of co-existing conditions on the current encounter is a crucial step in professional decision-making.

Scenario Analysis: This scenario presents a common challenge in rheumatology coding: accurately capturing the complexity of Systemic Lupus Erythematosus (SLE) and its associated manifestations. The professional challenge lies in discerning the primary diagnosis versus secondary conditions, understanding the nuances of coding guidelines for chronic diseases with multiple organ involvement, and ensuring that the documentation supports the chosen codes for appropriate reimbursement and statistical tracking. Misinterpretation can lead to under- or over-coding, impacting patient care continuity and financial integrity. Correct Approach Analysis: The best professional practice involves a thorough review of the physician’s documentation to identify the principal diagnosis and any co-existing conditions or complications directly attributable to SLE. This approach prioritizes coding the most specific diagnosis supported by the documentation. For SLE, this means looking for specific sub-types or organ system involvement (e.g., lupus nephritis, lupus cerebritis) and coding them as principal or secondary diagnoses as appropriate, alongside the general SLE code if necessary and supported. This aligns with standard coding principles that emphasize specificity and accurate representation of the patient’s condition. The justification is rooted in the fundamental coding guideline to code to the highest level of specificity documented, ensuring that the patient’s full clinical picture is represented. Incorrect Approaches Analysis: Coding only the general “Systemic Lupus Erythematosus” without further specificity, even when the documentation details specific organ involvement like lupus nephritis, fails to capture the full clinical picture and the severity of the patient’s condition. This is a failure to adhere to the principle of coding to the highest degree of specificity. Coding each documented manifestation of SLE (e.g., arthritis, rash, nephritis) as a separate, unrelated condition without linking them back to SLE as the underlying cause is also incorrect. This misrepresents the etiology of the patient’s symptoms and violates the principle of identifying the underlying disease when it is the cause of multiple conditions. Selecting a code for a specific manifestation of SLE (e.g., lupus nephritis) as the principal diagnosis when the physician’s documentation clearly indicates that SLE itself is the primary, overarching condition being managed, and the nephritis is a complication, is also an incorrect approach. This can misrepresent the primary reason for the encounter and the focus of care. Professional Reasoning: Professionals should adopt a systematic approach: 1. Thoroughly read and understand the physician’s complete documentation, including progress notes, consultation reports, and diagnostic findings. 2. Identify the principal diagnosis – the condition chiefly responsible for the patient’s admission or encounter. 3. Identify all co-existing conditions, complications, and manifestations that are documented and directly related to the principal diagnosis. 4. Consult the ICD-10-CM coding guidelines and relevant rheumatology-specific coding advice to determine the most accurate and specific codes for each identified condition. 5. Prioritize coding to the highest level of specificity documented by the physician. 6. Ensure that the sequence of codes accurately reflects the relationship between the principal diagnosis and its associated conditions.

Scenario Analysis: This scenario is professionally challenging because it requires a coder to differentiate between distinct rheumatological conditions that share overlapping symptoms but have different diagnostic criteria and treatment pathways. Accurate coding is paramount for proper patient care, billing, and statistical analysis. Misinterpretation can lead to incorrect treatment plans, denied insurance claims, and flawed research data. The challenge lies in the nuanced presentation of rheumatological diseases and the importance of precise documentation to support the chosen diagnosis code. Correct Approach Analysis: The best professional approach involves a thorough review of the patient’s complete medical record, including physician’s notes, laboratory results, imaging reports, and any consultation summaries. This comprehensive evaluation allows the coder to identify the specific signs, symptoms, and diagnostic findings that definitively point to one condition over another. For example, distinguishing between rheumatoid arthritis and osteoarthritis requires careful attention to inflammatory markers, joint involvement patterns, and radiographic evidence. Adhering to official coding guidelines, such as those provided by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) for ICD-10-CM and CPT coding respectively, is essential for accurate and compliant reporting. This approach ensures that the code assigned reflects the physician’s final diagnosis and the services rendered, aligning with regulatory requirements for medical necessity and accurate reimbursement. Incorrect Approaches Analysis: One incorrect approach is to rely solely on the chief complaint or the most prominent symptom documented by the physician without considering the full diagnostic workup. This fails to capture the definitive diagnosis and may lead to coding a symptom rather than the underlying condition, which is a violation of coding guidelines that prioritize reporting the most specific and definitive diagnosis. Another incorrect approach is to assign a code based on a preliminary or differential diagnosis without waiting for the physician’s final assessment and supporting documentation. This can result in inaccurate coding and potentially lead to billing errors and compliance issues, as coding should reflect the confirmed diagnosis. A further incorrect approach is to code based on assumptions or personal knowledge of common rheumatological conditions without verifying the specific details in the patient’s chart. This bypasses the critical step of documentation review and can lead to misrepresentation of the patient’s condition, violating ethical coding practices and regulatory mandates for accurate reporting. Professional Reasoning: Professionals should adopt a systematic approach that prioritizes comprehensive documentation review. This involves understanding the clinical context, identifying key diagnostic indicators, and applying the most current and relevant coding guidelines. When faced with ambiguity, the professional should query the physician for clarification rather than making assumptions. This ensures accuracy, compliance, and ultimately, supports appropriate patient care and healthcare system integrity.

Scenario Analysis: This scenario presents a common challenge in rheumatology coding where a patient exhibits symptoms that could be attributed to multiple underlying conditions, and the physician’s documentation reflects this diagnostic uncertainty. Accurately assigning codes requires careful interpretation of the physician’s notes, understanding the nuances of specific diagnostic codes, and adhering to coding guidelines that prioritize definitive diagnoses over symptomatic presentations when possible. The professional challenge lies in balancing the need for accurate representation of the patient’s condition with the potential for miscoding due to incomplete or evolving diagnostic information. Correct Approach Analysis: The best approach involves identifying and coding the most specific definitive diagnosis documented by the physician, even if other symptoms are also present. If the physician has documented a confirmed diagnosis of rheumatoid arthritis, that code should be used. This aligns with the principle of coding to the highest level of specificity available in the documentation. The rationale is that definitive diagnoses provide a clearer picture of the patient’s medical condition and are typically prioritized in coding systems for accurate reporting, reimbursement, and statistical analysis. This approach ensures that the coding reflects the established medical reality rather than a list of potential issues. Incorrect Approaches Analysis: One incorrect approach would be to code only the symptomatic presentation, such as joint pain, without assigning a code for the suspected or confirmed underlying rheumatologic disease. This fails to capture the primary reason for the patient’s visit and treatment, potentially leading to underreporting of specific conditions and inaccurate patient records. It bypasses the physician’s diagnostic efforts and the established coding hierarchy that favors definitive diagnoses. Another incorrect approach would be to assign multiple codes for every symptom mentioned in the documentation, even if they are all manifestations of a single, more specific underlying condition. This can lead to code bloat, overcoding, and a distorted representation of the patient’s health status. It violates the principle of coding for the condition that occasions the encounter and the need for specificity. A further incorrect approach would be to assign a code for a condition that is only suspected or being ruled out, without clear documentation of a confirmed diagnosis. Coding guidelines generally stipulate that codes for suspected conditions should not be assigned unless they are the definitive diagnosis for the encounter. This approach risks misrepresenting the patient’s condition and can lead to compliance issues. Professional Reasoning: Professionals should adopt a systematic approach to documentation review. First, thoroughly read the physician’s notes to identify the primary reason for the encounter and any definitive diagnoses. Second, consult coding manuals and guidelines to understand the specificity of available codes for rheumatologic conditions and their associated symptoms. Third, prioritize coding the most specific, confirmed diagnosis. If diagnostic uncertainty exists, follow established guidelines for coding uncertain diagnoses or consult with the physician for clarification. This process ensures accurate, compliant, and clinically meaningful coding.