Procedure Coding

Why do we use coding?

To tell why the patient was seen and what the provider did

2 Types of Codes

• ICD-10-CM: Whats wrong with the patient (diagnosis)

• CPT code: What the provider did (service or procedure)

Two parts of ICD-10 book

1. Alphabetic index: arranged in alphabetic layout by mainterms (diseases, conditions, with subterm underneath) - (look up name of the problem, gives you a starter code)

2. Tabular list: organizes conditions in a strict alphanumeric hierarchy (into chapters based on specific body systems) - (shows the full correct code, must check here before choosing the code)

ICD 10 Symbols

• “see” = look somewhere else

• “see also” = check another term if needed

• [ ] brackets = extra info or synonyms

• ( ) parentheses = optional words, incomplete terms

• NEC = no specific code exists

• NOS = not enough detail

• Includes = examples of what belongs in that category

• Excludes1 = Cannot be coded together

• Excludes2 = can be coded together

• Subterm = extra detail under main term

• Category = first 3 characters of a code

• Full code = complete ICD-10 code

• Laterality = 1-right, 2-left, 3- bilateral

Current Procedural Technology (CPT)

Tells insurance what the provider did

• Important because it is required for billing

• Must match the diagnosis

• Show the service performed

• Incorrect CPT code = DENIAL

E/M

Evaluation and Management

New Patient = Not seen in three years

Established patient = seen in three years

Compliance plan

Helps the offoce catch coding mistakes, prevent fraud, protect the practice

Fraud

Lying for financial gain

Downcoding

Payer reimbuses at lower code than submitted