Example Pain In Gallbladder K82 As A Coder

ICD-9-CM codes are the majority numbers only with the exception of those supplemental V and E codes, ICD-10-CM codes are all alphanumeric.

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

-Inpatient coders have certifications allowing them to work exclusively for hospitals or facilities. An expertise in medical record review is a must, along with an up to date status with coding rule changes, regulations and issues for medical coding, reimbursements and compliance under MS-DRG and Inpatient Prospective Payment Systems (IPPS). Coders should have experience as well as expert knowledge in abstracting information from medical records for ICD-9CM vol. 1-3, specialized payment in MS-DRG and IPPS.

Coding systems are used in the inpatient and outpatient settings for the classification of patient morbidity and mortality information for statistical use. The World Health Organization (WHO) developed the Ninth Revision, International Classification of Diseases (ICD-9) in the 1970s to track mortality statistics across the world. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), is the adaptation the U.S. health system uses as a standard list of six-character alphanumeric codes to describe diagnoses. Globally utilizing a standardized system improves consistency in recording symptoms and diagnoses for payer claims reimbursement, as well as clinical research, and tracking purposes.

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.

I am choosing ICD-10 Codes. The reason I have chosen ICD-10 codes is because every medical facility uses the ICD-10 codes for the billing and coding. That is the only way they get paid is by using ICD-10 codes. They will all receive adequate payments using the updated codes and the right type of billing.

ICD-10 is a huge change from ICD-9, the main purpose was to help coders code more specific. One benefit of ICD-10 is to give the doctor an electronic trail of proof for payments from patients, insurance, government, and hospitals. ICD-9 having diagnosis codes ranging from three to five digits but ICD-10 having diagnosis codes ranging from three to seven digits will automatically give you a more detailed code. Using ICD-10 gives you a lesser risk of getting audited. Giving a specific description on claim forms will make it harder to get the wrong code. ICD-10 will improve healthcare, the codes are more detailed making the data and communication flow faster. ICD-10's will help guarantee the physician reputation; the electronic trails are reported

The first digit in ICD-9-CM diagnosis codes is numeric except for codes in the supplemental chapters that include the letters E or V. The first digit in ICD-10-CM codes is always a letter.

- structure of diagnosis codes. Codes in ICD-10-CM have 3-7 characters where character 1 is alpha, and character 2 is numeric. On other side, there are 3-5 characters in ICD-9-CM where character 1 is numeric or alpha.

The majority of the time the use of HIM coders are involved in billing and reimbursements. However, coding specialists are important players within the healthcare industry.(Davis, 2014,2007,2002) They certify that providers maintain accuracy with coding procedures and government rules. (Davis, 2014,2007,2002) HIM functions and complex of regulatory requirements where coding can be very challenging. (AHIMA, 2016) The coders follow guidelines of the American Health Information Management Association AHIMA) Code of Ethics. (AHIMA, 2016) On the patient level, it is vitally important for the coder to code accurately because this information will trail the patient success throughout their course of treatment and beyond.

Having the lack of knowledge of the ICD-10 coding will not only affect our patients care from longer waiting time for authorizations to even denials. I also believe that it will affect the revenue that we receive into our facility from the insurance companies. Judith Veazie (October, 2014) author of the article “Creating an ICD-10 Training Strategy” states that no matter what field of healthcare you are in you will be affected by the current change to ICD-10. This new system provides better ways to submit your insurance claims for processing for reimbursement if coded properly. Veazie also says the benefit of ICD-10 is the specific amounts of codes that are now available to us which in return will be a benefit to our patients and facility.

Combination Codes- ICD-10 Makes it easier to code multiple diagnosis in one

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.

The outmoded coding professional’s role was to describe and apportion diagnosis, procedure, and other medicinal service codes using ICD-9-CM and HCPCS/CPT coding classifications while referencing the Coding Clinic for ICD-9-CM, Coding Clinic for HCPCS,

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.).