Comprehensive Medical Assisting, 3rd Ed Unit Three: Managing the Finances in the Practice Chapter 14 - Diagnostic Coding

Coding A way to standardize medical information by assigning numbers to a verbal statement or description Purpose Collecting statistics Performing a medical care review Indexing medical records Aid claims processing Basis for reimbursement

Current Procedural Terminology (CPT) Codes used to report services and procedures performed Determine the amount paid Must be reported accurately for proper payments

Medical Necessity Procedures or services that would be performed by any reasonable physician under the same or similar circumstances Advance beneficiary notice (ABN) Signed by a patient who has Medicare to ensure payment for treatment and procedures that will likely be denied by Medicare

Diagnostic Coding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Based on the International Classification of Diseases, ninth revision (ICD-9) developed by the World Health Organization (WHO)

Inpatient Versus Outpatient Coding Locations Health care provider’s office Hospital clinic Emergency department Hospital same-day surgery unit or ambulatory surgical center that releases patients within 23 hours Observation status in a hospital Inpatient A patient who is admitted to the hospital for treatment with the expectation the patient will stay 24 hours or more

Inpatient Versus Outpatient Coding Hospital Coders Code only services provided by the hospital and hospital employees Coders Employed by Physicians Code services provided by the physician no matter where the services are provided

ICD-9: The Code Book Code Updates Codes must be updated on any superbills or other forms used New codes are published every October Third-party payers require use of the new codes by the following January 1

ICD-9: The Code Book Volume 1: Tabular List of Diseases Classification of diseases and injuries by code number Groupings by Etiology Anatomic system

ICD-9: The Code Book Understanding the Code Three-digit codes followed by a title – describe specific diseases Fourth digit – breaks down the category further Fifth digit – highest level of definition

ICD-9: The Code Book Volume 1: Supplementary Classifications V-Codes V01 to V82 Index reason other than current illness for care E-Codes E800 to E999 Classify external causes of injury or poisoning Do not affect reimbursement

ICD-9: The Code Book Volume 2: Alphabetic Index to Diseases Contains many diagnostic terms that do not appear in Volume 1 Arranged by condition Three sections Section 1: Alphabetic Index to Diseases and Injuries Section 2: Table of Drugs and Chemicals Section 3: Alphabetic Index to External Cases of Injuries and Poisoning

ICD-9: The Code Book Volume 3: Inpatient Coding Used in inpatient facilities Based on anatomy, not surgical specialty

Locating the Appropriate Code Conventions Rules applied to assigning ICD-9 codes Found in Volumes 1 and 2 Main Term To be used when locating a diagnosis with more than one word Find the condition, not the location

Locating the Appropriate Code Primary Codes Code used to specify the patient’s chief complaint Listed first Using More Than One Code Many patients are given more than one diagnosis The most accurate picture of the patient’s condition should be represented

Conventions Used in ICD-9

Locating the Appropriate Code Late effects Symptoms or conditions that result from an acute illness Residual or current condition listed first; original illness listed second

End of Presentation