Transcript Chp_19_lesson_1_Intro_to_Coding__ICD_9_CM_manual

Pearson's Comprehensive
Medical Assisting
Administrative and Clinical Competencies
Second Edition
CHAPTER
CHAPTER
19
Medical Coding
Lesson 1:
Introduction to Coding and
The ICD-9-CM Coding Manual
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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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.
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
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Codes Used on Insurance
Claim Forms
• ICD-9-CM
– International Classification of Disease Ninth
Revision Clinical Modification
• CPT
– Current Procedural Terminology
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Critical Thinking Question
1. What might be the advantages of using
diagnosis and procedure codes when
trying to obtain reimbursement for patient
care?
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Purpose of Codes
• Provides information
to insurance carriers
regarding patient
diagnoses and
procedures
• Assists in the
communication
process to ensure
accurate and timely
reimbursement
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Knowledge and Materials Needed
to Be Proficient in Coding
• Knowledge:
–
–
–
–
Medical terminology
Diseases
Procedures
Anatomy and
physiology
• Materials:
–
–
–
–
Medical dictionary
Internet
CMS-1500
Superbill
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The Superbill
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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
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
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Copyright ©2011 by Pearson Education, Inc.
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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
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Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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History of Coding
1996: HIPAA is passed.
1988: Medicare Catastrophic Coverage is passed.
1979: ICD-9-CM is published.
1948: International Classification of Diseases is
published.
1937: The international List of Causes of Death is
Introduced.
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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The Profession of Coding
• American Health Information Management
Association (AHIMA)
• American Academy of Professional
Coders (AAPC)
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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
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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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
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Copyright ©2011 by Pearson Education, Inc.
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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
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Volume III of the ICD-9-CM
Coding Manual
• Provides information
on inpatient diagnosis
and treatment
• Used to code
inpatient hospitalbilled procedures
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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
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General Steps to Finding the
Correct ICD-9-CM Code
Step 3: Read the code to determine if code is
correct for condition and if fifth digit is needed.
Step 2: Find code number in the Tabular List.
Step 1: Locate the diagnosis with code number in the
Alphabetic Index.
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Coding a Closed Fracture of
Right Arm
• Look up “fracture” in the Alphabetic Index
• When “fracture” is found locate the word
“arm”
• Find code 818.0
• Look up code 818.0 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
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Principal Diagnosis
• Reason why patient
sought care that day
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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
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Copyright ©2011 by Pearson Education, Inc.
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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
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Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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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
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Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
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Abbreviations and Symbols Used
in the ICD-9-CM
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•
•
•
•
•
NEC
NOS
Brackets
Parenthesis
Brace
Bullet
•
•
•
•
Triangle
Two triangles
Boldface type
Italicized type
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
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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
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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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
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Copyright ©2011 by Pearson Education, Inc.
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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
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HCPCS
• Healthcare Common
Procedure Coding
System
• Used to report
services and
procedures for
Medicaid and
Medicare patients
• Consists of two
coding levels
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Copyright ©2011 by Pearson Education, Inc.
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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
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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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: 26010-F1
– Can be used in addition to the modifiers found
in the CPT manual
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.