Copyright ©2012 Delmar, Cengage Learning. All rights reserved. Chapter 15 Procedural and Diagnostic...

Copyright ©2012 Delmar, Cengage Learning. All rights reserved.

Chapter 15

Procedural and Diagnostic Coding


What is Coding?

• Converting descriptions of disease, injury, procedures, and services into numeric or alphanumeric descriptors

• Accurate coding maximizes reimbursement


The History of Coding

• International Classification of Diseases (ICD)– 1890s: a physician classified causes of death– The American Public Health Association

recommended this system to be used to classify deaths in North America

– 1938: ICD-5– 1978: ICD-9– 2013: ICD-10 (adopted in the US)


The History of Coding

• Current Procedural Terminology (CPT)– 1966: First published by the American Medical

Association– 1970: 5 digit codes introduced– 1983: Adopted as part of HCPCS– 2004: New, revised, and deleted codes must be

implemented every January 1


HCPCS

• Healthcare Common Procedural Coding System– Level I: CPT Codes– Level II: National Codes

• Services and products not covered by CPT codes– Codes published annually


CPT

• Codes for procedures or services• 6 sections of the CPT Manual

1. Evaluation & Management2. Anesthesiology3. Surgery4. Radiology5. Pathology and Laboratory6. Medicine


CPT

• Modifiers– Appendix A– Used when procedure/services needs to be

clarified or altered• Unlisted codes• CPT code symbols


CPT Coding Rules

• Select the name of the procedure or service that most accurately identifies the service performed– Typically marked on encounter form– If clarification is needed to determine the correct

code, seek the provider


ICD

• Codes for diseases or conditions• Establishes medical necessity• ICD-9 Manual

– Volume I: Tabular List– Volume II: Alphabetic Index– Volume III: Used by hospital coders


ICD Coding Rules

• Follow the reason rule• Code each problem to

the highest level of specificity


ICD-10

• 10th clinical modification– ICD-9 is not adequate to meet today’s needs– Allows for greater specificity in reporting diseases

• Coding system in place worldwide since 1990• Contains over 68,000 codes


Electronic Coding

• Encoders• Computer-assisted coding


Coding Accuracy

• Bundling or Unbundling• Upcoding or Downcoding• Medicare Audit

Copyright ©2012 Delmar, Cengage Learning. All rights reserved. Chapter 15 Procedural and Diagnostic...

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