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Coding Guidelines DHA

The Dubai Medical Coding Task Force operates under the Dubai Health Authority to guide healthcare providers on adopting standardized medical coding for electronic insurance claims in Dubai. The Task Force meets regularly and publishes coding guidelines on the eclaimlink.ae website. The guidelines outline approved medical coding systems such as ICD-10-CM for diagnoses and CPT codes for procedures. Certified medical coders are encouraged to accurately code patient diagnoses and procedures for insurance claims processing and data analysis. The guidelines are updated every 3 months to align with international standards and meet Dubai's coding needs.

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8K views6 pages

Coding Guidelines DHA

The Dubai Medical Coding Task Force operates under the Dubai Health Authority to guide healthcare providers on adopting standardized medical coding for electronic insurance claims in Dubai. The Task Force meets regularly and publishes coding guidelines on the eclaimlink.ae website. The guidelines outline approved medical coding systems such as ICD-10-CM for diagnoses and CPT codes for procedures. Certified medical coders are encouraged to accurately code patient diagnoses and procedures for insurance claims processing and data analysis. The guidelines are updated every 3 months to align with international standards and meet Dubai's coding needs.

Uploaded by

Mahesh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Dubai Medical Coding Guidelines

Dubai Medical Coding Task Force


Version 1.0
April 2012

The information contained in this document and any attachments herein is in draft format and is considered
confidential and intended only for internal discussions with involved parties. It is not intended for circulation.

Dubai Medical Coding Task Force


The Dubai Medical Coding Task Force is a group of professional coders and healthcare operators. This task force
operates under the Health Funding Department of the Dubai Health Authority. Its main scope is to guide the
healthcare community on the adoption and use of the medical coding sets to be used with regard to the electronic
claiming process in the Emirate of Dubai as part of its eClaimLink project.
The Task Force shall meet on a regular basis and shall release medical coding guidelines to the community as the
medical coding process evolve and mature. Meeting minutes and releases shall be published on the eclaimlink.ae
site.
Inquiries regarding Medical Coding can be directed to its members (names published on eClaimLink.ae site) or can
be sent to DHA at the following email address: [email protected]

Dubai Medical Coding Guidelines V 1.0 | P.1

Medical Coding
Medical Coding in Brief
Medical coding is the transformation of narrative descriptions of diseases, injuries, healthcare procedures and
observations into numeric or alphanumeric designations (that is, code numbers), following Guidelines and Rules.
The code numbers are detailed in order to accurately describe the diagnoses (the condition which reasoned the
encounter with the healthcare provider) and the procedures for either diagnostic or therapeutic purposes.
Because medicine is not always an exact science, codes were developed to identify all reasons for seeking
healthcare.
Medical coding is used for a variety of application in clinical care, research, education and billing medical insurance
claims:

statistical analysis and research of diseases and therapeutic actions


reimbursement of insurance claims between providers and payers
knowledge-based and decision support systems
direct surveillance of epidemic or pandemic outbreaks

Medical Coding and Insurance Claims


Medical coding provides a key step in the process of preparing and sending electronic claims (eClaims). Every time
a patient receives professional health care, be it in a physicians office, hospital outpatient or inpatient facility or
emergency services, home care or other locations, the provider must document the services provided. The Coder
will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid,
whether for the patient, insurance company or a TPA.
Medical Coding and Medical Billing
The Medical Coder is not responsible to ensure the invoices are paid properly. He/she is responsible for ensuring
that all documentation is accurately and completely coded. The medical coder is primarily responsible for
abstracting and assigning the appropriate coding on the claims. In order to accomplish this, the coder checks a
variety of sources within the patients medical record, (i.e. the transcription of the doctors notes, ordered
laboratory tests, requested imaging studies and other sources) to verify the work that was done. Then the coder
must assign CPT codes, ICD10-CM codes and HCPCS codes (for consumable and supplies only) to both report the
procedures that were performed and to provide the medical biller with the information necessary to process a
claim for reimbursement by the appropriate insurance company or TPA. Its important to clarify that the medical
coder should work independently from the finance department.

Dubai Medical Coding Guidelines V 1.0 | P.2

Expectations from Medical Coders

Apply coding rules to code all diagnoses and procedures, as applicable, to inpatient, day patient,
emergency patient and outpatient visits at the designated facility.

Perform data entry function of codes as well as other demographic and visit specific information to
facility coding database.

Utilize automated encoder (if applicable) to facilitate coding function, applying all appropriate coding
rules.

Perform quality improvement techniques to coding process in the form of audit and other techniques
to improve coding skills and outcomes, utilizing recognized benchmarks and resources.

Prepare statistical and analytical reports of coded data for facility administration and other requestors
as appropriate.

Participate in continuing education activities to maintain and improve coding skills as well as to stay
current with annual coding updates and changes, including coding seminars, article and conferences.

Certifications
There are many bodies that certify for professional coders; most relevant to Dubais selected coding sets are
AHIMA and AAPC. Providers and payers are highly encouraged to seek certified professional coders or certify their
existing staff in this regard to assure quality data coding.

Medical Coding and eClaims

Codes are used in eclaims in three important fields; diagnosis, activities and observations. Its important to
clarify that diagnosis and activities are mandatory fields at all times, while observations are not.
One primary diagnosis is mandatory in eclaims, and none to many secondary diagnosis are anticipated.
Also admitting diagnosis is an option. All diagnosis codes shall be ICD10-CM.
Activities are expected in encounters (visits), reflected in eclaims as one or many of the following codes:
CPT, HCPCS, DDC, CDT or DSL code.

Dubai Medical Coding Guidelines V 1.0 | P.3

Dubai Medical Code Sets


The Emirate of Dubai is adopting the following Coding Sets as its electronic claims (eClaims):
Coding System
International Classification of
Diseases - Clinical Modification
Current Procedural Terminology

Code
Designation
ICD 10-CM

Publisher

Version/Year

Domain

CMS & NCHS

2012

Diagnosis

CPT 4

AMA

2012

CMS

2012

CDT

ADA

2011-2012

Procedures - medical,
surgical, and diagnostic
services
Supplies and
Consumables
Dental procedures and
related services
Drugs and related

Healthcare Common Procedure


Coding System Level II
Code on Dental Procedures and
Nomenclature (American Dental)
Dubai Drug Code

HCPCS

Level II

DDC

DHA

Current

Dubai Service List

DSL

DHA

Current

Logical Observation Identifiers


Names and Codes
Systematized Nomenclature of
Medicine
Universal Numbering System
(Dental)

LOINC

RI

2012

SNOMED

IHSTDO

2012

UNS

ADA

2011-2012

Services assigned codes


for special cases
Laboratory and Clinical
Observations
Observations
Universal Tooth
Numbering
Observations

The task force scope covers all the above code sets except the Dubai Drug Code (DDC) which is handled by DHA
pharmaceutical Directorate. Approved observation codes & guidelines shall be published in future releases as
needed.

Dubai Medical Coding Guidelines V 1.0 | P.4

Coding Guidelines
The coding guidelines for the above coding set shall follow their publishers guidelines (e.g. AMA Guidelines for
CPT, CMS/NCHS guidelines for ICD10-CM and HCPCS, ADA guidelines for Dental, etc.). For any customized
guidelines for Dubai, the Dubai Medical Coding Task Force shall inform the healthcare community through regular
releases of its guidelines.
Coding Guidelines Releases
The Dubai Medical Coding Task Force shall release an updated version of the guidelines every 3 months; first
release is in April 2012.
Special Guidelines

It is anticipated that certain observations maybe requested by DHA or payers for certain activities as the
process evolve such as UNS for tooth numbering. The coding task force shall release lists of observations
that cover for such needs upon requests from stakeholders.
Evaluation / Management (E/M) CPT codes shall not be valid as codable or billable codes in Dubai eclaims;
Dubai Service List shall cover for those services, until further notice.
All procedures shall be coded and billed with CPT codes only. Any HCPCS procedure codes shall be invalid.
The Modifiers are not valid for coding or billing until further notice.
Dual coding with standard codes and non-standard service codes are allowed till end of Dec 2012, but
cannot use the non-standard codes alone in eClaims.

Dubai Medical Coding Guidelines V 1.0 | P.5

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