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CODING

This document provides information about medical coding systems. It discusses three main types of codes: ICD codes for diagnoses, CPT codes for procedures, and HCPCS codes which include CPT codes and additional codes for items/services. ICD-9-CM is currently used but will be replaced by ICD-10-CM in 2014. CPT codes describe medical procedures. HCPCS is used for Medicare/Medicaid claims and covers items not in CPT. National Drug Codes (NDC) are also discussed as a universal product identifier for drugs.

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Aaron Wallace
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364 views25 pages

CODING

This document provides information about medical coding systems. It discusses three main types of codes: ICD codes for diagnoses, CPT codes for procedures, and HCPCS codes which include CPT codes and additional codes for items/services. ICD-9-CM is currently used but will be replaced by ICD-10-CM in 2014. CPT codes describe medical procedures. HCPCS is used for Medicare/Medicaid claims and covers items not in CPT. National Drug Codes (NDC) are also discussed as a universal product identifier for drugs.

Uploaded by

Aaron Wallace
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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LEARN MORE ABOUT

MEDICAL CODING

TUTOR: MR AARON WALLACE BSN


NURSING. AMT PHLEBOTOMY TECH
WHY WE
CODE
● Coding condenses large
amounts of information
● Increases Efficiency
● Provides a universal language
for tracking
● the incidence of disease
● the efficiency of procedures
● performance management within
facilities
THREE TYPES OF
● ICD codes
● UsedCODES
for describing the diagnosis, injury,
and/or physical status of the patient

● CPT codes
● Used to describe the procedure or
service performed by the provider, or
the technology used in the service
● HCPCS codes
● Used to describe procedures, services, and
technologies, in addition to medical
equipment and medication
● Overlaps with CPT
● Used with Medicare, Medicaid, and many
third- party payers
ICD
● “InternationalCODES
Classification of Diseases”
● United States currently uses ICD-9-CM
● “International Classification of Diseases,
Ninth Revision, Clinical Modification”
● ICD-9-CM is going to be updated to ICD-
10-CM
in October of 2014
● ICD-9-CM: five characters, mostly numeric
● ICD-10-CM: seven characters,
entirely alphanumeric
● Used in the billing process to
demonstrate
medical necessity
CPT
CODES
● “Current Procedure Terminology”
● Five digits, mostly numeric
● Describe medical procedures
performed by the healthcare provider
● Different code ranges for
different procedures
● Divided into sections on …
CPT CODE
SELECTIONS
● Evaluation and Management
● Anesthesia
● Surgery
● Radiology
● Pathology and Laboratory
● Medicine
● Performance Management (Category
II)
● Emerging and experimental
procedures, services, and
technologies (Category III)
MORE ON
CPT
● CPT also has modifiers
● Add information about the procedure to the
code
● These modifiers may affect the status of the
claim
CPT
CODES
● Tell the payer which service the
healthcare provider performed on the
claim
● With ICD codes, CPT codes paint the
picture of the procedure: “we
performed (CPT code) because of (ICD
code)”
HCPCS
● “Healthcare Common Procedure
Coding System,” pronounced hick-
picks
● Based on CPT
● Divided into two levels
● First level is identical to CPT
● Second level covers services and
equipment not covered in CPT
● Like CPT, a HCPCS code should
correspond to
the diagnosis code (ICD code) listed
on the claim
● HCPCS also has modifiers that are
LEVEL II
HCPCS
● Includes codes for
● Ambulance services
● Injectable drugs
● Durable medical equipment (like
wheelchairs or splints)
● Prosthetics
● Many, many other items and services
HCPCS &
MEDICARE/MEDICAID
● HCPCS was developed by the Center
for Medicare Services (CMS)

● HCPCS is used when reporting a claim


to Medicare, Medicaid, and many
other third- party payers

● See Courses 2-10 and 2-11 for


more information on HCPCS
Medical Coding Systems
 Medical coding or, medical classification is the process
of transforming descriptions of medical diagnoses and
procedures into universal medical code numbers

 The diagnoses and procedures are usually taken from a


variety of sources within the health care records, such
as the transcription of the physician's notes, laboratory
results, radiologic results
 Are used to determine diseases, disorders,
and symptoms
 Diagnosti c codes
 Can be used to measure morbidity and

mortality
 Examples: ICD-9-CM, ICD-10

 Procedural codes
 They are numbers or alphanumeric codes used to
identify specific health interventions taken by medical
professionals.
 Examples: CPT

 Pharmaceutical codes
 Are used to identify medications

 Examples: NDC
1.ICD-9-CM

4International Classification of Diseases, Ninth Revision, clinical modification

 ICD codes are used to represent a doctor’s diagnosis and patient’s condition

 Developed by W.H.O in 1948 to track diseases

 ICD codes are updated by NCHS by daily basis

 US currently coding in ICD-9-CM systems

 In the billing process, ICD is used to determine medical necessity


Clinical modification

 Clinical modification is a set of revisions created by the National Center


for Health Statistics(NCHS)

 Clinical modification gives coders much more flexibility and specificity

 Ex.ICD-10 has 14,000 codes


but ICD-10-CM has 68,000+codes

 ICD-9-CM has reached its capacity of use as a coding systems

 ICD-9-CM changeover to ICD-10-CM in october of 2014

 ICD-10-CM provides more codes, more flexibility and accuracy in the


coding process
Anatomy of ICD-9 Code
Organization of ICD-9 Volume 1

001-139 Infectious and Parasitic Diseases


140-239 Neoplasms
240-279 Endocrine, Nutritional and Metabolic Diseases
280-289 Diseases of the Blood and Blood-forming Organs
290-319 Mental Disorders
320-389 Diseases of the Nervous System and Sense Organs
390-459 Diseases of the Circulatory System
460-519 Diseases of the Respiratory System
520-579 Diseases of the Digestive System
580-589 Diseases of the Genitourinary System
630-676 Complications of Pregnancy, Childbirth, and the
Puerperium
680-709 Diseases of the Skin and Subcutaneous Tissue
Organization of ICD-9 Volume 1
8

710-739 Diseases of the Musculoskeletal System & Connective


Tissue
740-759 Congenital Anomalies
760-779 Certain Conditions Originating in the Perinatal Period
780-799 Symptoms, Signs and Ill-defined Conditions
800-999 Injury and Poisoning
E800-E999 Supplementary Classification of the External Causes of
Injury and Poisoning
V01-V82 Supplementary Classification of factors influencing
Health Status and Contact with Health Services
Example

 Turn to that ICD code in Volume 1

786.5 Chest pain


786.50 Chest pain, unspecified
786.51 Precordial pain
786.52 Painful respiration
Pain:
Pleurodynia
anterior chest wall
pleuritic

EXCLUDES
786.59 Other

Discomfort
Pressure in chest
Tightness
2.CPT

 Current procedural Terminology

 Systematic listing of procedures & services performed by


physicians

 Five-digit codes for procedures or services

 Used to describe the physician’s services to a patient for


diagnosis and treatment of the medical condition(s)
Organization of CPT Manual

 Text organized in 6 major sections


Evaluation and Management (99201
(00100 - 99499)
01999, 99100-99140)
Anesthesiology
(10040 - 69990)
 Surgery
(70010 - 79999)
Radiology
(80049 - 89399)
 Pathology and Laboratory
 Medicine (90281 - 99199)
Example
Electrocardiogram (ECG or EKG) (CPT 93000)

Procedure code and description

93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and
report

93005 - Electrocardiogram, routine ECG with at least 12 leads; tracing only, without
interpretation and report

93010 - Electrocardiogram, routine ECG with at least 12 leads; interpretation and report
only

93040 - Rhythm ECG, 1-3 leads; with interpretation and report

93041 - Rhythm ECG, 1-3 leads; tracing only without interpretation and report

93042 - Rhythm ECG, 1-3 leads; interpretation and report only


3. National Drug Code
 The NDC, or National Drug Code, is a unique 10-digit, 3-segment number

 It is a universal product identifier for human drugs in the United States

 The code is present on all nonprescription (OTC) and prescription


medication packages and inserts in the US

 The 3 segments of the NDC code:


I. The first set of numbers in the NDC identifies the labeler (manufacturer,
repackager, or distributer).
II. The second set of numbers is the product code, which identifies the specific
strength, dosage form (i.e, capsule, tablet, liquid)
III. the third set is the package code, which identifies package sizes and types.
Example

The NDC for a 100-count bottle of Prozac 20 mg is 0777-3105-02

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