Medical Assisting Review Passing the CMA, RMA, and NHA Exams Fourth Edition © 2011 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Basic.

Medical AssistingReview

Passing the CMA, RMA, and NHA Exams

FourthEdition

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

Chapter 14

Basic Coding

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-2 Basic Coding

• Basic coding– Diagnostic– Procedural– Medical coding– Ancillary diagnostic services– Ancillary therapeutic services

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-3 Diagnosis Codes

• ICD-9-CM– Using the ICD-9-CM

• To facilitate the collection of health information• To compile statistical data• To index medical records

– Chief complaint– Etiology– Principal diagnosis– Preexisting diagnosis– Coexisting condition

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-4 Diagnosis Codes

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-5 Diagnosis Codes

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-6 Diagnosis Codes

• Tabular list – Volume 1– Divided by etiology and organ systems

• Anatomical system or type of condition• Related groups of codes• Third digit• Fourth digit• Fifth digit

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-7 Diagnosis Codes

• Alphabetical Index – Volume 2– Provides an index of disease descriptions in

the tabular list– Provides an index in table format of drugs and

chemicals that cause poisoning– Provides and index of external causes of

injury, such as accidents

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-8 Diagnosis Codes

• Special Codes– V codes– E codes– Symbols

• Square, bullet, triangle, facing triangle

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-9 Procedure Codes

• After an office visit, each procedure and service performed for a patient is reported on the healthcare claim using a procedure code– Using the Current Procedural Terminology

(CPT )– Locating correct codes– Add-on codes

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-10 Procedure Codes

• Modifiers

• Symbols– (□)– (●)– (▲)– (►◄)

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-11 HCPCS

• The Healthcare Financing Administration Common Procedure Coding System is used to report procedures and services for patients– Level I codes– Level II codes– Level III codes

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-12 Avoiding Fraud

• Claims fraud occurs when physicians or others falsely represent services or charges to payers– Provider bills for services that were not

provided– A patient exaggerates an injury to get a

settlement from an insurance company or a medical assistant is asked to change a date on a patient’s chart so that a service is covered by a health plan

McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

14-13 Avoiding Fraud

• Code linkage

• Coding for coverage

• Upcoding

• Double billing

• Correct coding initiative

• Mutually exclusive codes