Coding Service

Coding Support Information

Contact Name:

Title:

Hospital Name:

Hospital Address:

City:

St: Zip:

Phone:

Fax:

E-mail:

(required)

1. Annual number of discharges

2. ALOS

3. Percentage of discharges

	Medicare	Other Payers
	Medicaid

4. Specialty departments (to identify case mix)

Cardiac Surgery

Trauma Center

NeoNatal ICU

Psych Unit

Burn Unit

5. Abstracting Required? YES*     NO
    *If yes, please fill in abstracting guidelines

6. Data Entry Required: YES*     NO
    *If yes, please fill in entry guidelines
      and type of system used

7. # FTE Coders

8. Usual Daily Productivity

Include any comments or questions here:

NJPR
129 Littleton Road, Parsippany NJ 07054
(973) 334-3443 • (800) 562-7899
Fax (973) 334-2823