1. Medical Assisting Review Passing the CMA, RMA, and NHA Exams Fourth Edition © 2011 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Basic Coding

2. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-2 Basic Coding Basic coding –Diagnostic –Procedural –Medical coding –Ancillary diagnostic services –Ancillary therapeutic services

3. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-3 Diagnosis Codes ICD-9-CM –Using the ICD-9-CM To facilitate the collection of health information To compile statistical data To index medical records –Chief complaint –Etiology –Principal diagnosis –Preexisting diagnosis –Coexisting condition

4. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-4 Diagnosis Codes

5. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-5 Diagnosis Codes

6. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-6 Diagnosis Codes Tabular list – Volume 1 –Divided by etiology and organ systems Anatomical system or type of condition Related groups of codes Third digit Fourth digit Fifth digit

7. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-7 Diagnosis Codes Alphabetical Index – Volume 2 –Provides an index of disease descriptions in the tabular list –Provides an index in table format of drugs and chemicals that cause poisoning –Provides and index of external causes of injury, such as accidents

8. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-8 Diagnosis Codes Special Codes –V codes –E codes –Symbols Square, bullet, triangle, facing triangle

9. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-9 Procedure Codes After an office visit, each procedure and service performed for a patient is reported on the healthcare claim using a procedure code –Using the Current Procedural Terminology (CPT ) –Locating correct codes –Add-on codes

10. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-10 Procedure Codes Modifiers Symbols –(□) –(●) –(▲) –(►◄)

11. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-11 HCPCS The Healthcare Financing Administration Common Procedure Coding System is used to report procedures and services for patients –Level I codes –Level II codes –Level III codes

12. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-12 Avoiding Fraud Claims fraud occurs when physicians or others falsely represent services or charges to payers –Provider bills for services that were not provided –A patient exaggerates an injury to get a settlement from an insurance company or a medical assistant is asked to change a date on a patient’s chart so that a service is covered by a health plan

13. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14-13 Avoiding Fraud Code linkage Coding for coverage Upcoding Double billing Correct coding initiative Mutually exclusive codes