ICD-9 & CPT Coding

MIBC

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 paid by the third party insurance.

Medical Coder Medical Coder

o Thorough knowledge of anatomy and medical terminology.o 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.

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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.

o Proper assignment of ICD-9-CM codes corresponds with the physician’s diagnoses and completes the “story” of the patient’s illness or injury.

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

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

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

ICD-9 Index

ICD-9 Tabular

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

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)

CPT Index

CPT Tabular

Medical Biller The medical coder provides the medical biller with the

information necessary to process a claim for reimbursement by the appropriate insurance agency.

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