Billing and Coding Chapter 15 Basics of Diagnostic

Billing and Coding Chapter 15 Basics of Diagnostic Coding

ICD-9 -CM n Tracks healthcare statistics n Used as required participation in Medicare and Medicaid programs n Only assign codes that are supported by documentation n Always ask physician for clarification

The Evolution of ICD Coding 17 th century n 1937 n n 1948 n 1979 n 1988

Update to the ICD-9 -CM n New numbers n ICD-10 -CM

Volume 1, Tabular List Classifies diseases and injuries according to etiology and organ system n 5 groups n 4 subdivisions – Section – Category – Subclassification n Look at example p. 288 n

Volume 2, Alphabetic Index n Contains more information than the Tabular List n 3 sections

Volume 3, Procedures: Tabular List and Alphabetic Index n Contains a tabular and alphabetic index of procedures n Primarily n 2 -digits used in hospitals followed by a decimal and one or two additional digits

Symbols n Appear in the listings to serve as instructional notes n Symbols (p. 288)

Abbreviations n NEC n NOS

Punctuation and Notations n Punctuation n Notations – DEF – MSP – PDx – SDx (p. 289)

Steps in ICD Coding n Identify the key terms in the diagnostic statement n Locate diagnosis in alphabetic index n Read and understand any footnotes, symbols or instructions

Steps in ICD Coding (cont’d) n Locate the diagnosis in the Tabular List n Read and understand inclusions and exclusions n Make certain you include 4 th and 5 th digits when available n Complete example p. 289

Critical Thinking n If a patient presented with right lower quadrant pain and the physician simply wrote “R/O appendicitis” on the encounter form, how would Kay go about coding this?

V codes n Used when patient is not currently ill or to explain problems that influence their current illness

E Codes n Used to classify environmental causes of injury

Appendices n 5 included in Volume 1 – Morphology of Neoplasms – Glossary of Mental Disorders – Classification of Drugs by AHFS List – Classification of Industrial Accidents According to Agency – List of 3 -digit categories

Maximizing Third Party Reimbursement n Most important thing to remember n Tips – – – Use current ICD-9 -CM manuel, staying informed of changes Code accurately from documented information Be sure diagnosis corresponds with symptoms and treatment Review data entry to ensure no transposition of digits Know insurance carriers rules for submitting claims – Incomplete or inaccurate codes may result in insurance denial because of a lack of medical necessity

Legal and Ethical Issues n Be responsible n Be knowledgeable n Never change codes for insurance purposes n Deliberate misrepresentation may carry criminal and/or civil charges