Presentation on theme: " What is coding? Transformation of verbal descriptions into numbers Describes: Diseases Injuries Procedure."— Presentation transcript:
What is coding? Transformation of verbal descriptions into numbers Describes: Diseases Injuries Procedure
Official Guidelines for Coding and Reporting Appendix I Used by ALL healthplans Volumes 1-2 Cover diseases, injuries, impairments Cover other health problems Cover Causes of injury and disease Volume 3 covers procedures or other actions taken for disease, injury, or impairments HCPCS and CPT-4 are used for physicians and other healthcare services (i.e. ambulance, tests, therapy)
Classifications of Diseases and Injuries Supplementary Classifications ( V and E ) Appendices 17 Chapters/categories Volume 1 Sections (groups of 3 digits) Single disease or group of similar conditions Categories (3 digit) More specific than sections Subcategories (4 th digit) More specific re:signs, symptoms, secondary illness)
Fifth digit – Even greater specificity. ◦ (See page 5 in your book) Includes notes – further defines or provides an example. Excludes notes – directs you to look elsewhere Two supplementary classifications V Codes – Factors influencing Health Status and contact with Health Services E Codes – External Cause of Injury and Poisoning
Appendix A: Morphology of Neoplasms M code Appendix B: Abbreviations Appendix C: Mocroorganisms Appendix D: Commonly Used Drugs Appendix E: Morphology Terminology Appendix F: Sample Billing Forms Appendix G: Ethics in Coding Appendix H: Data Quality Appendix I: Previous slide - Guidelines
Index to Diseases and Injuries Main terms- boldface type Subterms- indented (modifiers) affect selection Carryover lines- needed to fit long term onto another line Nonessention modifiers- in parentheses- no effect on selection Eponyms – named after discovering physician, etc. Not all terms are in Tabular list that are in Alphabetic Index Cross-reference – item states see to send to alternate term. Direction must be followed. See also requires viewing another main term for best info.
Table of Drugs and Chemicals Alphabetic Index to External Causes of Injury and Poisoning (E codes)
Mandatory Multiple Coding – need to use more than one code to fully identify a given condition; includes “due to”, “secondary to”, or “with” – these may require multiple codes. When no combination codes available – use multiple codes. AVOID indiscriminate multiple coding. Not Elsewhere Classifiable Use with ill-defined terms More precise info is not available Not Otherwise Specified (Unspecified) Symbols Lozenge – square IDs code as unique to US Parentheses – enclose words or info that may or may not b present in statement of diagnosis Square brackets – enclose alternate words or phrases.
Volume 3 – includes Tabular and Alphabetic Combines with HCPCS Connecting words – subterms with as, by, or with Code also – reminder to code additional procedures when they have been performed Omit code – only used in volume 3 – no code is to be assigned Code incomplete procedures Code failed procedures
Principal procedure – was performed for definitive treatment rather than for diagnosis or exploratory purposes or for treatment of a complication
Minimum core data needed for payment: Personal ID – number assigned to patient DOBSexRaceEthnicityResidence Hospital ID – assigned to physician Disposition of patient – to home, AMA, another hospital, long-term, short-term, deceased Principal diagnosis – condition established after study to be chiefly responsible for the admission of patient Other diagnosis – All must be listed Complication Comorbidity (preexisting) Procedures w/dates - significant or principal
Principal Diagnosis: selection depends on the circumstances of admission, diagnostic tests, studies, symptom or illness could be changed after admission. Pages CAREFULLY read the guidelines for principal diagnosis