Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies Second Edition CHAPTERCHAPTER CHAPTER 19 Medical Coding Lesson 1: Introduction to Coding and The ICD-9-CM Coding Manual
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. Describe the purpose of diagnostic coding. Correctly apply the principles of ICD-9-CM coding. Describe the purpose of CPT coding.
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Codes Used on Insurance Claim Forms ICD-9-CM –International Classification of Disease Ninth Revision Clinical Modification CPT –Current Procedural Terminology
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Question 1.What might be the advantages of using diagnosis and procedure codes when trying to obtain reimbursement for patient care?
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Purpose of Codes Provides information to insurance carriers regarding patient diagnoses and procedures Assists in the communication process to ensure accurate and timely reimbursement
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Knowledge and Materials Needed to Be Proficient in Coding Knowledge: –Medical terminology –Diseases –Procedures –Anatomy and physiology Materials: –Medical dictionary –Internet –CMS-1500 –Superbill
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan The Superbill
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan The Superbill A document generated by the medical office Used as a charge slip, statement, and insurance reporting form Must be updated every year to reflect the most current diagnostic and procedural codes Provides a comprehensive list of the most frequently used patient procedure codes, services, and diagnosis codes used by that particular practice or physician
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan The Superbill Most offices have unique superbills created specifically for their practice based on their patient population Can be used as a reference base for traditional paper insurance forms and electronic claims
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan 1937: The international List of Causes of Death is Introduced. 1948: International Classification of Diseases is published. 1979: ICD-9-CM is published. 1988: Medicare Catastrophic Coverage is passed. 1996: HIPAA is passed. History of Coding
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan The Profession of Coding American Health Information Management Association (AHIMA) American Academy of Professional Coders (AAPC)
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan International Classification of Disease Converts medical terms into numeric and alphanumeric codes Classifies diagnosis codes Published by the World Health Organization (WHO) Codes are updated each year and available on or before October 1st
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Volume I of the ICD-9-CM Coding Manual The Tabular List Codes are listed in numerical order Contains: –17 chapters of disease and injury codes –V and E codes –Five appendices
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Volume II of the ICD-9-CM Coding Manual The Alphabetic Index Lists diseases and injuries found in the Tabular list Provides information on poisoning and adverse effects of chemicals and drugs Contains an index of injuries caused by external events
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Volume III of the ICD-9-CM Coding Manual Provides information on inpatient diagnosis and treatment Used to code inpatient hospital- billed procedures
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan The ICD-9-CM Code Each diagnosis is given a three-digit code Three-digit code = the main diagnosis code Fourth and fifth digits added to the main code provide more information If five digits care available to describe the patient’s condition then the five digit code must be used
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Step 1: Locate the diagnosis with code number in the Alphabetic Index. Step 2: Find code number in the Tabular List. Step 3: Read the code to determine if code is correct for condition and if fifth digit is needed. General Steps to Finding the Correct ICD-9-CM Code
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Coding a Closed Fracture of Right Arm Look up “fracture” in the Alphabetic Index When “fracture” is found locate the word “arm” Find code Look up code in the Tabular List Read the code description Determine if an additional digit is needed Note special notes and symbols to ensure correct code is selected
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Principal Diagnosis Reason why patient sought care that day
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Purpose of V Codes To code situations where the patient does not have a specific illness –For example: well-baby check or immunizations To provide more information regarding issues that may be impacting a patient’s health –For example: allergy to sulfur drugs
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Uses of Tables in the ICD-9-CM Manual Hypertension table – a diagnosis of hypertension must be coded from this table Neoplasm table – used to code neoplasms, whether benign or malignant Morphology table (M codes) – used to code the morphology (behavior) of the neoplasm Section listing various drugs and other agents – used to code adverse reactions or poisonings
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Purpose of E Codes To describe external causes of injury and poisoning or adverse effects To provide additional information regarding a particular diagnosis To provide further information on the cause of poisoning or adverse effects Must be used when coding the use of drugs
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Abbreviations and Symbols Used in the ICD-9-CM NEC NOS Brackets Parenthesis Brace Bullet Triangle Two triangles Boldface type Italicized type
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Comparing ICD-10 Codes to ICD-9 Codes Codes have been expanded to increase specificity and include recently discovered or diagnosed diseases Has more codes as well as organizational and content modifications Identification is from left versus right Conversion to using ICD-10 has been pushed back to 2012
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Expectations of ICD-10 Code Sets Support value-based purchasing and Medicare’s anti-fraud and abuse activities Support comprehensive reporting of quality data Ensure more accurate payments for new procedures and fewer rejected claims Improve disease management and harmonization of disease monitoring and reporting worldwide Allow the U.S. to compare its data with international data to track the incidence and spread of disease and treatment outcomes
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan CPT Codes Codes that describe medical, surgical, and diagnostic services Developed in 1966 by the American Medical Association (AMA) Assist providers in communicating what services and procedures were provided to the patient
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan HCPCS Healthcare Common Procedure Coding System Used to report services and procedures for Medicaid and Medicare patients Consists of two coding levels
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Contents of HCPCS Level I Codes for procedures and services Same codes as found in the CPT manual Provides additional codes not found in the CPT Contains twenty-two sections Codes are five-digit alphanumeric Codes are for items covered under Medicare such as materials, supplies, and injections
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan HCPCS Level II and Modifiers Level II contains codes that begin with a letter and then four numbers –Example: E1280 HCPCS modifiers: –Consists of two letters –Example of appearance: F1 –Can be used in addition to the modifiers found in the CPT manual
Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Questions?