MO230 Chapter 001

Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 1The Rationale for and History of

Coding

Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.2

Lesson 1.1: The Rationale for and History of Coding

Describe the application of coding. Define nomenclature and classification. Identify the historical timeline of coding. Explain the difference between ICD-9-CM and ICD-

10-CM. Delineate coder training needs for transitioning to

ICD-10-CM. Describe the different coding organizations and

credentials.


Lesson 1.1: The Rationale for and History of Coding

Recognize the importance of the Standards of Ethical Coding.

Define compliance as it relates to coding. Explain confidentiality as it relates to coding.


Background of Coding

What is coding, and what are its applications? International Classification of Diseases, 10th

Revision, Clinical Modification (ICD-10-CM & ICD-10-PCS)

Medicare Severity Diagnosis-Related Groups (MS-DRGs)


Background of Coding

Nomenclature Classification

Types of History of


History of Coding

1893: Bertillon’s Classification of Causes of Death

1898: Adopted by the American Public Health Association

World Health Organization (WHO) International Classification of Causes of Death

1977: Clinical Modifications (CMs) for U.S.


History of Coding

1993: ICD-10 published by the WHO In use in other countries Alphanumeric system Implementation in the U.S. slated for October

2014


History of Coding

ICD-9-CM updated twice a year Federal Register publication of updates

See www.cms.gov Current coding tools are a must!


History of Coding

Development & maintenance of guidelines: National Center for Health Statistics (NCHS) Centers for Medicare and Medicaid Services

(CMS) American Hospital Association (AHA) American Health Information Management

Association (AHIMA)


Preparation for Transition to ICD-10-CM

Differences between ICD-10-CM & ICD-9-CM Increase in the number of codes and code categoriesChange from numeric to alphanumericIncrease in digits from 5 to 7Increase from 17 chapters to 21 chapters


Preparation for Transition to ICD-10-CM

Coders must have in-depth knowledge of Anatomy and physiology Medical terminology Operative reports ICD-10-PCS definitions


Coding Organizations and Credentials

Where do coders work? Hospitals Physician offices Outpatient surgical centers Long-term care facilities Insurance companies Prisons Government agencies



American Health Information Management Association (AHIMA) Credentials: CCA Certified Coding Associate CCS Certified Coding Specialist CCS-P Certified Coding Specialist–

Physician-Based RHIT Registered Health Information

Technician RHIA Registered Health Information

Administrator



American Academy of Professional Coders (AAPC) Credentials: CPC Certified Professional Coder CPC-H Certified Professional Coder–

Hospital-Based CPC-P Certified Professional Coder–

Payer-Based



Certification examinations Keeping coding knowledge current

Continuing education units (CEUs) Minimums are required to maintain certification


Coding Ethics

AHIMA and AAPC have standards for ethical coding

Examples: Coding professionals should adhere to coding

guidelines They should only assign and report codes that are

supported by physician documentation They should maintain and enhance coding skills


Coding Ethics


Compliance

Follow the rules! Who makes the rules?

CMS State agencies Joint Commission

Increase in compliance programs Health Insurance Portability and Accountability Act

of 1996 (HIPAA) Increase in compliance officers


Compliance

Make sure you and your department are in compliance

Steps to ensure compliance Have a coding compliance plan What should be in the plan?


Confidentiality

Covered in: Patient Bill of Rights HIPAA

Common sense/need-to-know approach


QUESTIONS

MO230 Chapter 001

Economy & Finance

Transcript of MO230 Chapter 001