ICD-9 & CPT Coding

1. ICD-9 & CPT Coding MIBC

2. What is Medical Coding? • Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. • The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paidby the third party insurance.

3. Medical Coder • Medical Coder • Thorough knowledge of anatomy and medical terminology. • It is also important to become familiar with different types of insurance plans, regulations,  and the coding community’s critical resource books: CPT and ICD-9-CM along with their corresponding codes and guidelines. • Using coding books,  the medical coder assigns correct codes to record the service levels for the procedures performed and to account for supplies used to treat the patient during an encounter with the physician. • Proper assignment of ICD-9-CM codes corresponds with the physician’s diagnoses and completes the “story” of the patient’s illness or injury.

4. International Classification of Diseases and Conditions, 9th Edition • alphanumeric designations given to every diagnosis, description of symptoms and cause of death attributed to human beings. • Used by government health authorities to track diseases and conditions and show uniformity

5. ICD-9, 3 Volumes • Volume 1: TABULAR LIST • Volume 2 : ALPHABETIC INDEX • Volume3: HOSPITAL PROCEDURES • The correct coding process is to locate a term and its code in the Alphabetic Index (Volume 2) and to verify the code in the tabular (Volume 1) • Codes can be 3-5 digits long depending on the specifity needed to code the disease/condition

6. How to Find A DX Code… • A 6 year old boy with chronic tonsillitis receives a tonsillectomy. • 1st: Identify the main term as the DX: What is wrong? • 2nd: Identify the main term as the procedure: What are they doing? • 3rd: Recognize that age may play a key factor in assigning the correct/accurate code

7. ICD-9 Index

8. ICD-9 Tabular

9. Current Procedural Terminology • Every medical, diagnostic, or surgical procedure or service has an associated 5-digit CPT code assigned to it • The standard for doctors, coders, patients, and insurance companies to label and identify medical services and procedures

10. CPT • The CPT manual has an Index and Tabular as well • The Index is located in the back of the manual • The Tabular is located at the front of the CPT manual • Categorized by body systems (Urinary, Respiratory)

11. CPT Index

12. CPT Tabular

13. Medical Biller • The medical coder provides the medical biller with the information necessary to process a claim for reimbursement by the appropriate insurance agency.

14. And Last but not Least • In October 2014, the Medical Billing and Coding world will implement a new standard of coding. • We will evolve from 17,000 ICD-9 codes to approximately 141,000 ICD-10 codes • http://www.youtube.com/watch?v=KrVePG1TIag