CPT Procedural Codes

you were in uses a list of codes that are not accepted by the CPT manual. So now, when your records get taken to the hospital nearest

ICD-9-CM codes could before be labeled in just one code, now with more clinical detail to sort through, ICD-10-CM have many more codes to choose from that are much more detail oriented and specific.

As you can imagine, ICD-10 codes allow for far greater specificity in clinical documentation. For example, the old ICD-9 system did not address laterality nor the episode of care. The old system also lacks other clinical specificities. For example, ICD-9 had one single code for a closed fracture of the femur (821.01) whereas ICD-10 will have at least 24 codes dealing with these kinds of

The E/M code's is a big important part in this process. Being a health care professional, using the medical code's. like medicare, medicaid, other private insurance to be reimbursement. If not using the right code, the doctor office, hospital, and urgent care. Will lose a lot of money. So using the right cpt code's insurance companies, office, hospital, and urgent care can be reimbursement correct. Cause CPT code's are formed with 5 digits.

The continue use of ICD-9 codes after the effective date could result in the denial of reimbursement claims. This task can be assigned to the healthcare organization’s management team to determine a solution avoiding a break down in the system. Rahmathulla states, “In instances of an audit, appropriate documentation will make the query process substantially easier while enabling coders to clarify issues without having to query the provider multiple times for answers” (“Migration To The ICD-10 Coding System S187). It is important to accurately document to reduce the amount of claim denials. With the new specificity requirement of the ICD-10 and documentation supporting a claim, lowers the chances of healthcare fraud. The healthcare management team will oversee the process to prevent the risk of exposure.

We as Coders and Billers should understand the interaction of the CPT procedural codes and the ICD diagnostic codes. The providers receive payment for their service, whether it is an office visit or an operation in the hospital. All services need to be coded for proper payment.

Medical coding, on the other hand, deals more closely with patient medical records. Medical coders work in the billing office, or “back office” of medical practices or hospitals. Alphanumeric codes are assigned to all illnesses, injuries and treatments. Medical procedures are coded for the purpose of classifying diseases in numerical sequences for identification and data collection purposes, similar to the Dewey Decimal System in libraries. Coding specialists review medical records and assign numeric codes for the diagnoses identified and procedures performed. Each medical procedure and patient encounter has a number (CPT code) associated with it which corresponds to an ICD code. These

To determine the CPT code for the above case scenario, the first step is to identify its category 1 which in this case will be emergency department services which range from code 99281-99288. In this category, the case scenario would also be assigned code 78000-79999 for nuclear medicine and code 76500-76999 for diagnostic radiology. The codes would be selected based on the chest x-ray and nuclear stress test done to the patient. Codes 99605-99607 would also be assigned based on the medication given to the patient. In category II of CPT, the case scenario would be assigned code 0500F – 0575F for patient management based on patient evaluation and prescription changing.

- structure of procedure codes. Codes in ICD-10-PCS have 7 characters where each of them can be either alpha or numeric. Compare to ICD-9-CM, there are 3-4 characters where all characters are numeric.

ICD-10 – CM is a three- to seven character alphanumeric representation of a disease or condition. The first digit is alpha; Digit 2 is numeric. There is a decimal placed after the third character. There are 69,000 codes to better capture specificity, tis also

CPT coding is to make sure the patient is getting billed for the correct services that was rendered. The Tabular list is a compilation of codes divided in different categories: Category I, II, III. Category I is the basis of CPT codes. Category II is used for tracing information. Category III is short term codes for collection of services rendered and procedures. There are 15 appendices that are used as guides. Modifiers help report situations. Locating codes are done by finding the main term. Assess information provided such as notes and terms. Locate the code. Guidelines are presented in the front of the sections. Special instructions help point out rules on how to use codes. Instructional notes are located in parentheses

Due to ICD-9-CMS’ ability to provide necessary detail for patients’ medical conditions or the procedures and services performed on hospital patients, ICD-10-CM/PCS was implemented.

ICD-10, which is the tenth revision of the International Statistical Classification of Diseases and Related Health Problem, refers to a medical classification inventory for the coding of diseases, their signs, symptoms and causes (Center for Disease Control and Prevention 1). The use of this revised version in the United States is scheduled to begin officially on the first of October 2013. Currently, ICD-10 is being used for diagnosis coding, in procedure coding systems and for inpatient procedure coding.

There is an accentuation on the need for quality of coded data with the use of computer-assisted coding in healthcare organizations to assure compliance is being met with regards to the increasingly multifaceted quality reporting requirements.

specialist determine the ICD, CPT or HPCS coding. The coder or biller may have to communicate with the healthcare provider if there are any questions on any of the diagnoses, treatments or duration of the office visit (Dietsch, 2011). Because insurance companies are very strict on correct medical billing and coding, a small mistake can cause the insurance company to deny the claim and will then require the doctor to fix the error and the claim will need to be resubmitted (Cocchi & White, n.d.).