Universal Medical Codes

Under the references comes the 3M Coding Reference Plus, and it contains AHA Coding Clinic for HCPCS, Coders’ Desk Reference for Procedures by Optum, Anesthesia Crosswalk, Faye Brown’s ICD-9-CM Coding Handbook, and ICD-10-CM and ICD-10-PCS Coding Handbook. The References include introductions, changes in the ICD coding, and guidelines for coders to find and better understand the coding process. For example, the Anesthesia section provides the section of the surgery and next to it the section where the right code can be assigned. Then, the Coding Clinic for HCPCS provide some articles and questions with their answers related to coding and the changes to some codes. These references are crucial in the coding sector, especially with the changes that occur on some codes and modifiers. Coders should be aware of the references and use them to avoid intention and non-intention mistakes, frauds or abuse.

"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.

necessary because they are used primarily to identify products, supplies, and services not included in CPT codes such as drugs and

.The purpose of the HCPCs , Level 2 alphanumeric codes are used to report services, supplies and equipment, such as walkers , wheel chairs , oxygen, medicines , provided to Medicare and Medicaid patients , for which no codes exist . HCPCs codes can also be required on non-Medicare and Medicaid patients, because some third-party payer's follow Medicare and Medicaid guidelines and may require that a HCPCs Level 2 code also known as G codes , be assigned. There are also certain HCPCs level 2 codes required by all payer's , such as drug codes also known as j codes. You would find these codes used in out-patient settings , rehabilitation services, doctor's offices , and you would also use them for supplies used , medications and or equipment

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.

Uninformative codes can create confusion to what the code details. This language needs to be clear and detailed so that the health care organizations can provide the best health care as possible. When codes are

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

HIPAA requires two designate coding system to be used to report to private and public payers; this is HCPCS and ICD-10. This coding system is primarily used in the United States and it is used by healthcare providers, including physicians and hospitals. Icd-10 is useful for reporting inpatient and HCPCS is used for procedure reporting for outpatient service and they are both assigned to DRG group. Once the health service is performed, charge captures are slips that are posted to a patient’s account that is processed as a batch order system. The key to the ordering system and charge capture is the “charge code” which is then reflected each service, procedure, supply item or drugs in the chargemaster (CDM). Medical claims fall into one of two types: CMS

One of the greatest milestones in the United States health system is the use of electronic health records codes to ensure consistency in diagnosis and treatment procedures provided by physicians (Romano & Stafford 2011). The purpose of the case scenario of the sixteen year old female who visits the emergency department is to show how electronic health record coding is done and its impact on health reimbursement. The International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes are brought out well in the case study showing how they help in ensuring physician consistency in coding diagnosis and treatment procedures for the purpose of health reimbursement.

An accurate and specific documentation of universally accepted set of codes are important for the protection of healthcare providers as well as increased reimbursement for services received. These codes are for the validation of which services the patient received from their health care provider ( (Page, 2009). Having the correct codes in place insures the provider with the information needed by the health insurance carrier. Maintained by the AMA (American Medical Association), this universal numeric assignment is also used for developing guidelines for medical care review as well as data collection for medical education and research (Scott, 2013).

Averill, Richard F. (1996). The Development of the ICD-10 procedure coding system (ICD-10-PCS): Draft. Wallingford, CT: 3M Health Information System.

“A procedure document includes relevant information like the date of the procedure, the patient’s name, and his or her date of birth. More importantly, a procedure document includes the doctor’s diagnosis and the procedure performed.”(Medical Billing and Coding). They turn the medical coding into medical cost for that claims can process. They are also there to catch any errors such as making sure the correct diagnosis was made as well as no inaccurate information about the

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.).