Copyright ©2012 Delmar, Cengage Learning. All rights reserved. Chapter 15 Procedural and Diagnostic Coding
Jan 19, 2018
Copyright ©2012 Delmar, Cengage Learning. All rights reserved.
Chapter 15
Procedural and Diagnostic Coding
Copyright ©2012 Delmar, Cengage Learning. All rights reserved.
What is Coding?
• Converting descriptions of disease, injury, procedures, and services into numeric or alphanumeric descriptors
• Accurate coding maximizes reimbursement
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The History of Coding
• International Classification of Diseases (ICD)– 1890s: a physician classified causes of death– The American Public Health Association
recommended this system to be used to classify deaths in North America
– 1938: ICD-5– 1978: ICD-9– 2013: ICD-10 (adopted in the US)
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The History of Coding
• Current Procedural Terminology (CPT)– 1966: First published by the American Medical
Association– 1970: 5 digit codes introduced– 1983: Adopted as part of HCPCS– 2004: New, revised, and deleted codes must be
implemented every January 1
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HCPCS
• Healthcare Common Procedural Coding System– Level I: CPT Codes– Level II: National Codes
• Services and products not covered by CPT codes– Codes published annually
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CPT
• Codes for procedures or services• 6 sections of the CPT Manual
1. Evaluation & Management2. Anesthesiology3. Surgery4. Radiology5. Pathology and Laboratory6. Medicine
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CPT
• Modifiers– Appendix A– Used when procedure/services needs to be
clarified or altered• Unlisted codes• CPT code symbols
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CPT Coding Rules
• Select the name of the procedure or service that most accurately identifies the service performed– Typically marked on encounter form– If clarification is needed to determine the correct
code, seek the provider
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ICD
• Codes for diseases or conditions• Establishes medical necessity• ICD-9 Manual
– Volume I: Tabular List– Volume II: Alphabetic Index– Volume III: Used by hospital coders
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ICD Coding Rules
• Follow the reason rule• Code each problem to
the highest level of specificity
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ICD-10
• 10th clinical modification– ICD-9 is not adequate to meet today’s needs– Allows for greater specificity in reporting diseases
• Coding system in place worldwide since 1990• Contains over 68,000 codes
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Electronic Coding
• Encoders• Computer-assisted coding
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Coding Accuracy
• Bundling or Unbundling• Upcoding or Downcoding• Medicare Audit