Mary Jo Bowie MS, BS, AAS, RHIA, RHIT

Introduction to Coding and Coding Professions CHAPTER 1 Introduction to Coding and Coding Professions

Medical Coding The assignment of numerical or alpha-numerical digits and characters to specific diagnostic and procedural phrases. Each combination represents a diagnostic or procedural phrase.

Purpose of Coding Enables the healthcare industry to collect diagnostic and procedural information more effectively Allows for processing of medical information Provides an organized system to analyze diagnostic and procedural information

Professional Coding Coding is a language used by healthcare providers and insurance companies to tell the story of why the patient was seen and what treatments the patient received. The codes enhance communication between all concerned parties.

History of Coding World Health Organization (WHO) is responsible for the development of the International Classification of Diseases. Every ten years the classification is updated. Currently ICD-10 is used throughout the world.

History (cont.) In the United States, ICD-10 is modified and is known as the International Classification of Diseases, Tenth Revision, Clinical Modification, ICD-10-CM. This is used to report diagnoses. ICD-10-PCS Procedure Coding System is used to report procedures and treatments. This is only used in the United States.

Updates to ICD-10-CM/ICD-10-PCS The National Center for Health Statistics (NCHS) is responsible for the annual updates to the ICD-10-CM codes. The Centers of Medicare and Medicaid Services (CMS) is responsible for the annual updates to ICD-10-PCS.

Final Rule on ICD-10-CM/ICD-10-PCS On January 16, 2009, the federal government published the final rule on the adoption of ICD-10-CM and ICD-10-PCS. Implementation date is scheduled for October 1, 2014.

Public Law 104-191 This public law, also known as the Health Insurance Portability and Accountability Act of l996 (HIPAA), developed standards for the electronic exchange of healthcare data. The final rule mandated the use of standardized code sets. The codes are used to determine payment and medical necessity of care.

Medical Necessity of Care Medicare defines Medical Necessity of Care as: “The determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.” Coders are used to select codes that represent the treatment and the reason for the treatment based on the medical documentation present in the patient’s record.

Professional Coding Associations Professional Coding Associations have developed to assist and promote correct coding and reimbursement. Credentialing of coders helps to ensure proper training and education of coders.

American Health Information Management Association (AHIMA) AHIMA represents health information professionals. These professionals are responsible for the management, organization, processing, and manipulation of patient data.

AHIMA Credentials The following credentials are available: Certified Coding Associate (CCA) Certified Coding Specialist (CCS) Certified Coding Specialist, Physician Based (CCS-P) Certified in Health Data Analyst (CHDA) Certified in Healthcare Privacy and Security (CHPS)

AHIMA Credentials (cont.) Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT) To maintain certification, individuals are required to obtain continuing education credits.

American Academy of Professional Coders (AAPC) Credentials obtained from AAPC include: Certified Professional Coder (CPC) Certified Professional Coder Apprentice (CPC-A) Certified Professional Coder, Hospital-Based (CPC-H) Certified Professional Coder, Hospital-Apprentice (CPC-H-A)

American Association of Medical Assistants (AAMA) Credentials obtained through AAMA include: Certified Medical Assistant (CMA) Professionals with this credential perform both administrative and clinical duties.

American Medical Technologists (AMT) The AMT offers the following credential: Registered Medical Assistant (RMA) Duties include both administrative and clinical functions.

American Medical Billing Association (AMBA) AMBA offers the following credential: Certified Medical Reimbursement Specialist credential (CMRS) The association provides services for medical billers.

Medical Association of Billers (MAB) MAB offers the following credentials: CMBS- Certified Medical Billing Specialist CMBS-CA- Certified Medical Billing Specialist for Chiropractic Assistants CMBS-H- Certified Medical Billing Specialist for Hospitals CMBSI- Certified Medical Billing Specialist for Instructors

Employment Opportunities for Coders The U.S. Bureau of Labor Statistics calculates that the growth of coding jobs in the United States will grow faster than the average of all other occupations through 2015. Credentials coders are valuable in the healthcare industry.