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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
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