1. Front Office Procedures
Coding and Insurance

2. Coding consists of . . .
Diagnostic Coding
Procedural Coding

3. What is Diagnostic coding???
Coding is converting verbal or written descriptions into numeric designations

4. 784 is the diagnostic code for. . .
For example:
784 is the diagnostic code for. . .

5. Headache
Ouch!
Headache!

6. An insured patient goes to see his doctor for a headache.
This is how it works-
An insured patient goes to see his doctor for a headache.
Then Doctor X gives the headache a code number (784)
And sends the proper paperwork to the patients’ insurance company with that code number.

7. ABC Insurance company receives the paper work with the code: 784
Coding . . .yeah!
ABC Insurance company receives the paper work with the code: 784
For the patient and one look at the number tells ABC Insurance company that their insured was seen for a 784
Or. . .

8. OUCH
A Head Ache!

9. Procedure codes
Mr. Bean has seen Doctor X several times over the last three years, this makes him an. . .
ESTABLSIHED PATIENT

10. Mr. Bean saw Doctor X for a short visit –about 15 minutes
Procedure codes
Mr. Bean saw Doctor X for a short visit –about 15 minutes
And he only had one problem to discuss with the doctor
Mr. Bean’s visit was a problem focused, limited exam

11. Procedure codes –yippee!
So Doctor X sends this information to Mr. Bean’s Insurance company as well, in the form of a number.
This number is for the procedure
It is called a Procedure Code
99212

12. Codes, codes, codes
Once ABC Insurance Company receives the paper work, called a claim, they review the code numbers and . . .

13. Decide what to pay Doctor X
Codes, codes, codes
Decide what to pay Doctor X

14. Doctor X bills ABC Insurance Co. $175.00 for an office visit
Amount due:
Doctor X bills ABC Insurance Co.
$ for an office visit
ABC Insurance Co. only has to pay Doctor X a portion of that amount.
They decide to pay. . .

15. payment
$75.00

16. Everyones happy

17. Because The doctor gets paid.
The patient only has to pay a small amount of money to see his doctor- this is called a Co- pay.

18. Everyone is happy
ABC Insurance will continue to receive monthly amounts of money from Mr. Bean- this is called a premium.
AND- Mr. Bean has already paid his deductible, which is an amount of money that Mr. Bean has to pay every year towards his Insurance claims.

19. Recap-
Mr. Bean pays a small amount out of his paycheck every month so that when he goes to see his doctor, Doctor X, he only has to pay a vary small amount called a co- payment.
Doctor X’s office collects the co-payments from their patients, like Mr. Bean and the monies collected from the Insurance companies and this is how the office makes money

20. Insurance coding
The End.