MEDICAL CODING

1. MEDICAL CODING INTRODUCTION FOR A CAREER Presented by Lyn Olsen,Ph.D., MPA, RHIT, CCS, CPC-H, CCS-P, CPC www.tseas.wordpress.com

2. WHAT IS MEDICAL CODING AND BILLING? • MEDICAL CODING & BILLING ARE THE CORE OF ADMINISTRATIVE MEANS BY WHICH HEALTHCARE PROVIDERS ARE PAID • INVOLVES ABUNDANT REGULATIONS BY A MULTITUDE OF GOVERNMENT AGENCIES WITH SERIOUS FINES FOR FRAUD AND/OR ABUSE (check websites www.cms.gov and www.oig.hhs.gov for more information) • IF CODERS AND BILLERS FAIL TO DO THEIR JOB WELL, HOSPITALS AND DOCTORS MAY BE UNABLE TO PRACTICE AND PATIENTS MAY NOT BE ABLE TO RECEIVE PROPER SERVICES

3. ICD-9 • ICD IS THE INTERNATIONAL CLASSIFICATION OF DISEASES AS DEVELOPED BY THE WORLD HEALTH ORGANIZATION TO TRACK THE OCCURRENCES OF DISEASES SO THAT PATIENTS CAN BE MORE EFFECTIVELY TREATED • UNITED STATES USES THIS SYSTEM TO SELECT DIAGNOSTIC CODES AS PART OF THE PAYMENT PROCESS TO ENSURE MEDICAL NECESSITY • ICD CODES ARE NUMERIC AND CAN VARY FROM 3 DIGITS TO 5 DIGITS WITH THE 4TH AND 5TH DIGITS LOCATED TO THE RIGHT OF THE PERIOD AND THE REST OF THE DIGITS ARE LOCATED TO THE LEFT • THERE ARE TWO ADDITIONAL SECTIONS FOR E (EXTERNAL INFLUENCES) CODES AND V CODES (SUPPLEMENTAL CODES) • THERE ARE THREE VOLUMES CONTAINED WITHIN ONE BOOK: • VOLUME 1 IS THE TABULAR INDEX OR CODES • VOLUME 2 IS THE ALPHABETICAL INDEX • VOLUME 3 IS THE TABULAR INDEX OF HOSPITAL PROCEDURES AND IS NOT USED BY PHYSICIANS OR HEALTHCARE PROVIDERS BECAUSE THEY USE THE CPT CODES

4. CPT • CPT IS THE CURRENT PROCEDURAL TERMINOLOGY WHICH IS DEVELOPED BY THE AMERICAN MEDICAL ASSOCIATION • CPT PROVDES CODES FOR VARIOUS SERVICES PROVIDED BY HEALTHCARE PROVIDERS, SUCH AS DOCTORS AND TECHNICIANS • CPT BOOK IS COMPOSED OF CODES AND AN ALPHABETICAL INDEX • CPT BOOK ALSO HAS APPENDICES WHICH ARE IMPORTANT WITH USE OF CODES, SUCH AS THE MODIFIERS • CPT CODES ARE 5 DIGITS NUMERIC AND MODIFIERS CAN BE ATTACHED MARKED BY A HYPHEN BETWEEN THE CPT CODE AND THE MODIFIER • SECTIONS OF THE CPT BOOK INCLUDE EVALUATION & MANAGEMENT FOR VISITS, ANESTHESIOLOGY, SURGERY, RADIOLOGY, LABORATORY/PATHOLOGY AND MEDICINE.

5. HCPCS • HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) • HCPCS LEVEL I ARE THE CPT CODES • LEVEL II ARE ALPHANUMERIC AND DEVELOPED BY THE CENTERS FOR MEDICAID AND MEDICARE SERVICES (CMS), A PART OF THE HEALTH AND HUMAN SERVICES FEDERAL DEPARTMENT. • LEVEL II CODES ARE USED TO CODE FOR PAYMENT OF NON-PHYSICIAN SERVICES INCLUDING AMBULANCE SERVICES, PROSTHETIC DEVICES, AND SUPPLIES AND MATERIALS INCLUDING DRUGS AND MEDICATIONS. • HCPCS ALSO HAVE MODIFIERS

6. MEDICAL CODING AS A CAREER CHOICE • AS A CAREER, MEDICAL CODING AND BILLING JOBS ARE EXAGGERATED TOO OFTEN BY TOO MANY WITH FEW PROMISES FULFILLED • QUALITY IS CRITICAL AND YOU NEED TO MAKE YOUR DECISION TO START THIS CAREER WITH A QUALITY COMPREHENSIVE EDUCATION • CREDIBLE TRAINING INVOLVES MANY HOURS OF INSTRUCTION BY QUALIFIED INSTRUCTORS FOR THERE IS MUCH TO KNOW • TRAINING SHOULD INCLUDE MEDICAL BILLING, TERMINOLOGY, AND HEALTH ADMINISTRATION

7. MEDICAL CODING CERTIFICATION • CERTIFIED CODERS ARE HIGHLY VALUED WITH HIGHER SALARIES AND GOOD JOB SECURITY • IT IS RECOMMENDED THAT CODERS BE CERTIFIED AS PHYSICIAN CODERS FIRST AND THEN ADVANCE TO HOSPITAL CODING IF DESIRED • PHYSICIAN CODING INVOLVES CODING FOR HEALTHCARE PROVIDER SERVICES WITHIN DOCTOR OFFICES, CLINICS, URGENT CARE AND EMERGENCY ROOM • HOSPITAL CODING IS DISTINGUISHED AS OUTPATIENT AND INPATIENT • OUTPATIENT HOSPITAL CODING IS FOR SERVICES WHEN THE PATIENT IS NOT ADMITTED TO THE HOSPITAL SUCH AS OUTPATIENT SURGERY CENTERS • INPATIENT HOSPITAL CODING IS FOR SERVICES PROVIDED BY THE HOSPITAL, SUCH AS ROOM AND BOARD, SUPPLIES, NURSING STAFF

8. LEGITIMATE HEALTH ADMINISTRATIVE CERTIFYING AGENCIES • AHIMA: AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION (ahima.org) • OFFERS CERTIFICATION AS CERTIFIED CODING SPECIALIST FOR THE PHYSICIAN (CCS-P) AND CERTIFIED CODING SPECIALIST (CCS) FOR INPATIENT AND OUTPATIENT HOSPITAL • OFFERS CODING CERTIFICATION AS AN APPRENTICE (CCA) • OFFERS CERTIFICATION AS REGISTERED HEALTH INFORMATION TECHNICIAN (RHIT) AND ADMINISTRATORS (RHIA) WHO MANAGE CLINICS AND HOSPITAL DEPARTMENTS AS WELL AS MANY OTHER JOBS • AHIMA HAS BEEN INVOLVED IN MANY HEALTH ADMINISTRATION PROJECTS WITH MEDICAL AND GOVERNMENTAL AGENCIES FOR OVER 75 YEARS

9. LEGITIMATE HEALTH ADMINISTRATIVE CERTIFYING AGENCIES • AAPC: AMERICAN ACADEMY OF PROFESSIONAL CODERS (aapc.com) • OFFERS CERTIFICATION AS CERTIFIED PROFESSIONAL CODER (CPC) AND CERTIFIED PROFESSIONAL CODER (CPC-H) FOR OUTPATIENT HOSPITAL CODING • PROVIDES TRAINING AND CONTINUING EDUCATION UNITS WITHIN THE CODING FIELD

10. ONLINE COMPREHENSIVE MEDICAL CODING COURSE • Three Sisters M&E Services offer high quality and comprehensive training in medical coding • Derived from 15 years experience teaching, writing, consulting, and presenting in the health administration including preparation of students for coding exams • Experience enhanced by the instructor’s five national certifications in healthcare administration (RHIT, CCS, CPC-H, CCS-P & CPC) • Online courses developed by instructor so no cost for books • Course consists of 30 packets for ICD-9 and 30 packets for CPT/HCPCS. • Cost is $500 per course for a total of $1000 for both courses.

11. FOR MORE INFORMATION CONTACT www.tseas.wordpress.com