Chapter 19: Medical Coding
ICD-9-CM
Superbill
Special Codes
- International Classification of Diseases, Ninth Revision, Clinical Modification
- Three volumes
- Volume III
- Inpatient treatment
- Not used in most ambulatory care setting
- Volume I
- Tabular List
- 17 chapters of disease and injury codes
- V and E codes
- Volume II
- Alphabetic Index
V Codes
- Document generated by the medical office
- Provides a list of most frequently used procedure codes, services, and diagnosis codes
E Codes
- Used to describe a person who may not have a current illness but uses the health care system for some specific purpose
- Examples:
- Well-baby care
- Birth control advise
- Pregnancy test
- Immunizations
- Used to describe external causes of injury and poisoning or adverse offers
- Should not be used as primary or principal diagnoses
- Meaning do not stand alone
- Used to further define the cause
HCPCS
CPT
ICD-10
- Healthcare Common Procedure Coding System
- To report services and procedures for Medicaid and Medicare patients
- Level I and Level II
- Codes are updated on yearly basis
- Updated by American Medical Association (AMA)
- Organized numerically or alphanumerically
in sections of types of service
- Most commonly used codes are Evaluation and Management (E/M)
Level II
- Codes are for the items that Medicare covers
- Examples:
- Materials
- Supplies
- Injections
- International Classification of Diseases, Tenth Revision
- Increased specificity
- Include recently discovered or diagnosed diseases
Level I
- CPT
- Current Procedural Terminology
- Provides comprehension list of procedure and service codes
Evaluation and Management
Patients
CPT
Modifiers
- Two-digit code preceded by a hyphen that clarifies the procedure
- Used when procedure code does not accurately describe the procedure
Codes based on following criteria:
- History of patient
- Complexity of examination
- Degree of difficulty in medical
decision making
Four Levels of Decision Making
New patient
- Has never been seen by anyone in the practice
- Has not been seen by anyone in a particular practice for more than 3 years
Established patient
- One who has been seen within the past 3 years by any physician within that practice
Symbols
- Distinguish changes or give instructions to be used while coding
- Add additional information or instructions for proper coding of certain procedures
- Straightforward
- Low complex
- Moderate complex
- High complex