What is medical coding and what is it used for?
"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.
What coding systems are used in the United States?
"In the United States, ICD-10 has been used to classify mortality data since 1999, while we continue to use ICD-9-CM for all other purposes, such as billing and morbidity statistics. In addition, government agencies, health care insures, and providers are studying the implications of switching to ICD-10-CM." (Aalseth, 2006) …show more content…
With changes in time and life, society changes. And with those changes comes new ideas, disease and illnesses never before encountered or diagnosed. For example; in 1993 a newly understood form of HPV cancer was identified and therefore, a code had to be assigned. In such cases, The ICD-9-CM Coordination and Maintenance Committee in joint effort with the National Center for Health Statistics and the Center for Medicare and Medicaid Services, considers changes yearly. (Aalseth, 2006)
What is ICD-10 and why was it mandated to use
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Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can leads to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.
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
In 1978, the World Health Organization published ICD-9. It was later modified by the US Public Health Service so that it could service the needs of American hospitals. This modification was named International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM). As of October 1, 2015, ICD-9-CM was replaced with ICD-10-CM. ICD-10-CM was considered an upgrade from ICD-9-CM because it was more specific and contained many more codes than its predecessor. Most of the categories contained in ICD-9-CM were completely full with no room for expansion. ICD-10-CM goes into a lot more detail than ICD-9-CM. ICD-10 has been upgraded to contain up to seven digits as opposed to the four to five that were associated with ICD-9.
The code set are said to be outdated and no longer meet the demand of healthcare, additionally ICD-9 cannot support many of the health IT and data exchange initiatives which made the implementation of ICD-10 an essential move. ICD-10 was implemented 1 October 2015 despite being one of the most feared events. The new system now saw Government agencies and payers provided with greater specificity on the conditions of the patients being treated (Conn & Herman, 2015). Additionally, it will also facilitate payers’ ability to profile specific providers, gauge outcome performance and adjust reimbursement based on the outcomes. Other improvement includes coding details connection with the data needs of accountable care organizations. Furthermore, there are a variety of conditions that were not uniquely defined in ICD-9-CM that now have an assigned code in ICD-10-CM. In the past, if a condition was not defined, coders had to determine the best way to code a condition, with the update, there will most likely be a specific code that will need to be used. Postoperative complication codes have been expanded. This will allow for distinction between intra and post-operative
ICD-10-CM is the acronym for which is known to the International Classification of Diseases tenth revision clinical modification. provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), for medical coding and reporting in the United States. This code system is used for decades by doctors and healthcare industry worldwide to diagnose diseases and conditions in standard ways. The ICD-10 is not a new simple version of the previous standard otherwise, the adoption of this code will impact all aspects of the healthcare industry. The change will require not only the acquisition and implementation of new equipment and computerized programs, it also take a more detailed process of medical
The National Center for Health Statistics (NCHS) is part of the ICD-9-CM coordination and maintenance committee. This committee is responsible for maintaining the classification system. NCHS is responsible for the classification of diagnoses involving volumes 1 and 2. NCHS posts the updated material for official code revisions to the classification systems, known as addenda on their centers for disease control and prevention website for the diagnostic portion. NCHS is also responsible for the use of the international statistical classification of diseases and related health problems. Some of the improvement that NCHS has help make are the addition of information relevant to ambulatory, managed care encounters, more injury codes, the making
The biggest challenge from switching to ICD-10-CM to ICD-9-CM would be having to be more specific and havin longer codes. It would also include more information than the ICD-9-CM. We would also have to have people who already code by the ICD-9-CM to switch to ICD-10-CM, they probably wouldn't feel comfortable with a change, especially because ICD-9-CM is already a challenge itself. Having to get familiar with the medical terms as well. For the ICD-10-CM I think would have more numbers and letters to pick from just not "U".
Originally slated for October 1, 2014, the Centers for Medicare & Medicaid Services (CMS) had planned to replace the current ICD-9 codes sets with the new ICD-10 code sets. However, on March 31, 2014, the Senate approved a bill that has delayed the implementation until at least October 2015. The numbers of the ICD means “International Classification of Diseases” (ICD) and the numbers nine and 10 describe therefer to “editions,” just like with books. ICD defines designations prescribed for every possible description of symptom, cause of death, or diagnosis that a human may experience. These codes are utilized used for reporting medical diagnoses as well asand inpatient procedures, according to the CMS. Everyone who works in conjunction with the Health Insurance Portability Accountability Act (HIPAA) is required to adopt these code set changes. The CMS has issued a reminder that ICD-10 will not impact affect coding for physician services and outpatient procedures.
Nevertheless, with the date of implementation already expired, larger facilities gain an advantage, whereas smaller practices lag behind (Conn, 2015). That is to say, ICD-10 doesn’t purposely affect health care facilities negatively. Wall (2016) further identifies the impact of ICD-10 with regards on data capturing. It is important to note that data capturing is further improved to capture undetectable data not thought possible. Data can include the under dosing of drugs, which further clarifies two classifications (e.g. specific drugs underutilized, and reason for drug misuse), which play a significant role with the Centers for Medicaid and Medicare Services data collection, hospital resource utilization, and potential future reimbursement.
Hospitals are experiencing a greater need for specialized coding services in the wake of the transition to ICD-10. New challenges emerge for hospitals, as ICD-10 has revamped diagnosis and procedure coding and creates the need for hospitals to upgrade to the ICD-10-(PCS) Procedure Coding System if inpatient procedure data is reported.
There are literally thousands and thousands of medical codes in the health care field and probably one for just about every scenario, disease, and procedure you can imagine. I never knew just how interesting coding could be until I enrolled in the MBC associates program at Community Care College. If medical billing and coding is something you are interested in, I encourage you to visit my blog at jamiemjohnson.wordpress.com to find more interesting facts.
I agree Roshanda, the purpose of coding is to ensure accurate reimbursement for services that were provided to a patient. Coding works the same way as the medical terminology a physician would learn. Physicians need to know the proper medical terminology for procedures, diagnosis, and body parts etc in order to communicate with other physicians and healthcare providers. Well it works the same way with the insurance companies. Insurance companies uses coding as their way of communicating with each
The codes use alphanumeric characters in all positions, not just the first position as in ICD-9. In addition, there are 68,000 existing codes in the ICD-10, as opposed to the 13,000 in ICD-9. Therefore, the codes have been greatly expanded and this expansion allows a significant increase in the specificity of the reporting in the ICD-10, allowing more information to be conveyed in a code. For instance if you had a burn on your right arm in did not specify which arm had the burn in the old ICD-9, now in ICD-10 it specifies which arm has the burn. The terminology has been modernized and has been made consistent throughout the code set. There are codes that are a combination of diagnoses and symptoms, so that fewer codes need to be reported to fully describe a condition. The reason they changed it is because the practice of medicine has changed considerably in the last 25 years, and the ICD needed to reflect those change. There have been many new diseases discovered, new type of medical devices and new treatment and the