Coding

what is ICD-10-CM?

Its the international classification of diseases, 10th revision, clinic modification

What is ICD-10CM used for?

its used to report patient diagnoses

what does a ICD-10-CM identify as?

• diseases

• injuries

• medical conditions

• patient status

• other reasons for health care encounter

examples of ICM-10-CM

• hypertension

• falls, poisoning

• signs/symptoms

• screening

• vaccination

Section 1

Conventions, general coding guidelines, chapter specific guidelines

Section 2

selection of principal diagnosis

section 3

reporting additional diagnoses

section 4

diagnosis coding and reporting guidelines for outpatient services

E11

type 2 diabetes mellitus code

coding placeholders in order

category, subcategory, subclassifications, extension

What does CPT stand for?

Current Procedural Terminology

What does CPT identify as?

• medical services

• Procedures performed by provider

Examples of CPT?

• office visit

• laboratory test

• lesion removal

What is section 1 CPT title

Evaluation and Management

What is section 2 CPT title

Anesthesia

What is section 3 CPT title

Surgery

What is section 4 CPT title

Radiology

What is section 5 CPT title

Pathology and Laboratory

What is section 6 CPT title

Medicine

What does HCPCS stand for?

Healthcare Common Procedure Coding System

What does a HCPCS identify as?

• supplies

• procedures

• services not in CPT

Examples of HCPCS?

• medical supplies

• therapies

• transportation

Code A HCPCS code

• transport services

• medical and surgical supplies

• administrative

• miscellaneous

• investigational

Code B HCPCS code

enteral and parenteral therapy

Code C HCPCS code

CMS hospital outpatient payment system

Code D HCPCS code

dental procedures

Code E HCPCS code

medial and surgical equitment

Code H HCPCS code

behavior health and/or substance abuse treatment

Code J HCPCS code

drug

Code M HCPCS code

other medical servises

Code P HCPCS code

laboratory services

Code V HCPCS code

vision and hearing services

what category is the most referenced in HCPCS?

category J

how often are HCPCS codes updated?

quarterly (4 months)

how are modifiers characterized by?

pricing

Concurrent care

Similar care provided by more than one physician at the same time.

critical care

Care provided to unstable, critically ill patients with constant bedside attention needed.

consultation

Care provided or discussed with another physician at the request of the primary physician.

counseling

part of the evaluation and management process without a complete history and physical

downcoding

When the insurance payer reimburses at a lower level than the CPT code submitted, it results in reduced payment for the provider

unbundling

Separating a bundled procedure into individual CPT codes to boost reimbursement

upcoding

Intentionally using higher-level codes than the services provided, in order to receive increased reimbursement

What information should you have before beginning a claim?

• patient insurance company, policy number, group plan number, member number

• name of the person receiving the services

• whether the patient has a second insurance or additional coverage

• reason of visit