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Medical coding

Applications of Health Informatics. Medical coding. John Graunt began the statistical study of disease in the early 17 th century 1837 William Farr wanted adoption of a uniform classification of causes of death

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Medical coding

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  1. Applications of Health Informatics Medical coding

  2. John Graunt began the statistical study of disease in the early 17th century 1837 William Farr wanted adoption of a uniform classification of causes of death In 1893 Jacques Bertillon developed the Bertillon classification of Causes of Death and the U.S. began using that system around 1898 The name was changed in 1938 to International classification of Diseases (ICD) History

  3. In 1978, the ninth edition of the classification system was published and included “Clinical Modification” (CM) to its title. The new name International Classification of diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is the one still used today – although transition is beginning for the 10th (ICD-10-CM) edition now. • Originally it was a 3-volume set, established by the WHO in 1977, but has now been condensed into 1 book that contains either two or three of the volumes giving offices the choice of buying one book containing the volume specific to its need

  4. Originally, the purpose of the ICD system was to provide morbidity statistics for the WHO (World Health Organization) Today, all medical offices use the coding system to provide information to verify the need for patient care/treatment and to provide statistics for analysis of health care costs ICD coding translates written medical terminology into codes using a universal language Payers check the condition to the care provided to determine if the services are medically necessary and, therefore, reimbursable purpose

  5. In the beginning, physicians were only required to give simple descriptive phrases or 1st 3-digits of the diagnosis, but today, Federal agencies and most payers require correct diagnosis coding and reimbursement which are directly impacted on those codes. Now, 5-6 digits are required for more specific diagnosis’ & treatments Coding must meet federal guidelines compliance

  6. The introduction to each book provides important information to help coders understand the basic uses of the ICD-9-CM books ICD-9 contents

  7. In the diagnostic coding system, codes are broken down into a 3-digit category, • Ex: code 250 – diabetes mellitus • then broken down further into a 4th digit subcategory to give info about patient condition • Ex: code 250.0 – diabetes mellitus without mention of complication • And a 5th digit sub-classification based on descriptive terms needed to complete the diagnosis, or specificity, for coding. • Ex: code 250.00 – diabetes mellitus without mention of complication, type 1 [insulin dependent] [IDDM type] [juvenile type] or unspecified type, not stated as uncontrolled Format of Icd-9-cm

  8. Volume I – • tabular list: numerical listing of diseases/injuries and contains 17 chapters groups by etiology (cause) or anatomical (body) site. • Volume II – • Alphabetic index: listing of codes to assist in locating the complete code in volume I • Volume III – • Tabular alphabetical and numerical listing used mostly by hospitals. It includes a tabular list of procedures by anatomical site, miscellaneous diagnostic and therapeutic procedures and an alphabetical index Volume understanding

  9. To use the coding system, coders need to understand the symbols, abbreviations and other conventions used within the ICD-9-CM • These are usually found in the introduction of the volume. These are some of the conventions that are important to diagnostic coding • Print type • Bold face • Volume I - All title and codes are printed in bold type • Volume II – main term is printed in bold face conventions

  10. Italics • Both volumes use italics to highlight all exclusion notes and to identify codes that should NOT be used as the primary code • Ex: code 359.5, myopathy in endocrine disease classified elsewhere • In this case, the code is written in italics with the instruction to code first the underlying disease, such as Addison’s disease, 255.4 because Addison’s is the primary diagnosis followed by the myopathy (manifestation) or secondary diagnosis. • Primary dx: 255.4 Addison’s disease • Secondary dx: 395.5 myopathy in endocrine disease classified elsewhere

  11. Have good research habits  • 5 basic steps to finding the correct code • Correctly identify the main term/condition • Use the index to locate the condition/problem • Review information given following all instructions • Locate and confirm the correct code in the tabular list and select the correct code • Put codes in correct sequence when using multiple diagnoses • Main/primary diagnosis should be coded as the condition or reason that patient sought medical care • Ex: patient with a history of ulcers (533.9) was seen for acute pharyngitis (462). How to find icd-9-cm code

  12. An important factor in coding is reading the notes and other instructions provided with a code • V-codes are supplemental classification codes for factors that influence a patient’s care • May be used with a patient sees the doctor without a complaint or problem (sports exam, etc.) or to describe conditions that could influence patient care (allergies, etc.). There are 3 main categories • Problems – something that could affect overall health • Services – patient returns for a problem/treatment • Factual findings – description of facts for statistics Other icd-9-cm elements

  13. E-codes are optional codes that describe the following: • Events or circumstances • Causes of injury or poisoning • Other adverse effects • Should never be used as a primary or stand-alone code • Its function is to provide details of an incident or injury and help identify the following • Automobile accident liability • Worker compensation situations • Third-party insurance liability

  14. Newest version was actually released by the WHO in 1992, but the U.S. has yet to implement the system because the NCHS (National Center for Health Statistics) determined the new version was not sufficiently detailed for use within the national health care system. In the new version, volumes 1 and 2 will be completely replaced by ICD-10-CM and volume 3, used by hospitals will be replaced by ICD-10-PCS which is developed by the Centers for Medicare and Medicaid Services (CMS) Icd-10-cm: preview

  15. The objectives of the ICD-10-CM coding system is to offer • Completeness – unique code for each illness or disease • Expandability – new injuries or disease can be incorporated easily into the existing structure • Standardization – terminology will be defined for standardization with each term being assigned a specific meaning

  16. Icd-9-cm Icd-10-cm • Tabular • Alphabetic index • Procedures • 17 chapters • Numerical code system • 4th and 5th digit specificity • Category for unspecified codes • Supplementary class for V and E codes • Tabular • Alphabetic index • Procedures • 22 chapters • Alpha-numerical code system • 6th and 7th digit specificity • Limited use of unspecified codes • Supplementary class for V and E codes • New chapters for disease of eye and ear instead of inclusion in nervous system comparison

  17. Putting it all together Need: Worksheet 1 Worksheet 2 Worksheet for V & E codes ICD-9-CM – all volumes Adams, W. (2004). Coding and Reimbursement A simplified approach. Mosby, Inc. St. Louis Missouri.

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