TEST REVIEW

Outside agencies use ICD-9 codes for: FIRST STEP IN REIMBURSEMENT PROCESS OF HEALTH CLAIMS IS – reading and understanding the physicians reports DX codes submitted on insurance claims age generally used to determine benefit coverage Outside agencies use ICD-9 codes for: Conducting studies and trends in a disease Forecast healthcare needs Review costs

London Bill of Morality was first introduced mainly to warn about plaque epidemics PURPOSE OF ICD-9 PAGE 66 Use of Date Page 66 WHEN ARE THE UPDATES FOR ICD 9 available?

LATE EFFECT CODES (residual) Code the late effect followed by the cause of the late effect

E Codes Examples: Accidental falls Assaults poisonings

Neoplasms 3 choices from table under Malignant Primary Secondary Carcinoma in situ

CPT used 5 digit codes CPT – CURRENT PROCEDURAL TERMINOLOGY Published by the AMA CPT manual is organized numerically and alphanumerically in sections by type of service Used to code services and procedure Updated yearly, updates are available on January 1st CPT used 5 digit codes

CPT has 8 sections: Category I is 6 sections Category II 1 section Category III 1 section To use CPT manual 1st look up the service/procedure in the INDEX in the back of the manual Commonly accepted descriptions of the code are located after the code number ONLY codes that STAND ALONE have a full description Procedures and services are listed under: the condition/disease service/procedure anatomic site

CPT Category I Describe procedures and services Restricted to clinically recognized and generally accepted services

Category II Optional tracking codes (developed principally for performance measurement) Facilitate data collection , codes certain test and services that contribute to positive health outcomes and quality patient care May be included in Category I coding Do not have relative value associated with them Are assigned a numeric-alpha identifier with the letter ‘F’ in the last field These are optional codes

Category III Category III Temp codes for emerging technologies Services that are in for FDA approval Not intended for use with services/procedures that have not been accepted by the CPT Assigned a numeric-alpha with a ‘T’ Located in a separate section, following the CPT Category II code section HIPPA supports deleting tis section

Category I Contains 6 sections Evaluation and Management E/M – 99201 – 99499 Anesthesia – 00100 – 01999, 99100 – 99140 Surgery 10021 – 69990 Radiology 70010 – 79999 Pathology and Laboratory - 80047 – 89356 Medicine 90281 – 99199, 99500 – 99607

Look up CPT codes in index by: Classes of main entry CC Organ/anatomical site Synonyms/eponyms/abbreviations first code (parent code) Appears left-justified in a series of codes

SYMBOLS: BOLD Upper Case = code sections or chapter headings Bullet = New Code Plus -Sign = Add on Code Parenthesis = Encloses Additional Information Triangle = Revised Code Circle with line though it = Modifier 51 Exempt CPT hierarchy (from the largest to the smallest) Section, subsection, subheading, category Locate the main terms by service or procedure, anatomic site, condition or disease.

Modifiers Used to indicate that the description of the service is prolonged or altered 50- bilateral (most commonly used modifier) 47 – anesthesia by a surgeon Used properly will increase reimbursement

HCPCS Acronym for: HCPCS Level II codes Healthcare Common Procedural Coding System Level 1 codes (CPT codes) HCPCS Level II codes DME durable medical equipment, prosthetics, orthotics, injections, ambulance services, dental procedures, surgical supplies, etc CMS updates annually Consists of alphanumeric code – ex – E0745