MEDICAL CODING

Mushtaq Ahmad Wani15PIM2244

M.S. (Pharm.) 3rd SemesterDepartment Of Pharmacoinformatics

NIPER, S.A.S. Nagar

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Medical coding systems

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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

Medical coding systems.

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Diagnostic codes Are used to determine diseases, disorders, and

symptoms 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: CPTPharmaceutical codes

Are used to identify medications Examples: NDC

1.ICD-9-CM4

International 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

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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

Clinical modification

Anatomy of ICD-9 Code6

Organization of ICD-9 Volume 1

001-139 Infectious and Parasitic Diseases 140-239 Neoplasms240-279 Endocrine, Nutritional and Metabolic Diseases280-289 Diseases of the Blood and Blood-forming Organs290-319 Mental Disorders320-389 Diseases of the Nervous System and Sense Organs390-459 Diseases of the Circulatory System460-519 Diseases of the Respiratory System520-579 Diseases of the Digestive System580-589 Diseases of the Genitourinary System630-676 Complications of Pregnancy, Childbirth, and the

Puerperium680-709 Diseases of the Skin and Subcutaneous Tissue

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Organization of ICD-9 Volume 1

710-739 Diseases of the Musculoskeletal System & Connective Tissue

740-759 Congenital Anomalies760-779 Certain Conditions Originating in the Perinatal Period780-799 Symptoms, Signs and Ill-defined Conditions800-999 Injury and PoisoningE800-E999 Supplementary Classification of the External Causes of

Injury and PoisoningV01-V82 Supplementary Classification of factors influencing

Health Status and Contact with Health Services

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Example

Turn to that ICD code in Volume 1

786.5 Chest pain786.50 Chest pain, unspecified786.51 Precordial pain786.52 Painful respiration

Pain: Pleurodyniaanterior chest wallpleuritic

786.59 Other

DiscomfortPressure in chestTightness

EXCLUDES

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2.CPT 10

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)

Codes and descriptive terminology developed and copyrighted by AMA CPT Editorial Panel

Organization of CPT Manual 11

Text organized in 6 major sectionsEvaluation and Management (99201 - 99499)Anesthesiology (00100 - 01999, 99100-99140)Surgery (10040 - 69990)Radiology (70010 - 79999)Pathology and Laboratory (80049 - 89399)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

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3. NDC13

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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