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

2. 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

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

4. 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

5. 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)

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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

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

14. 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

15. 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

16. Conventions Used in ICD-9

17. 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

18. End of Presentation