ICD-10 Coding System

"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.

This standardized dialect is also pertinent for medical schooling and teaching in addition to clinical research and studies conducted by scholars, scientists, and physicians by providing a valuable foundation for domestic and coast-to-coast operation evaluations. CPT is used to describe doctor’s services, a vast amount of administrative services in addition to operating services executed in medical facilities, treatment care centers, and outpatient divisions. Providing support for clerical duties and functions such as processing medical claims and initiating strategies and procedures for the evaluation of clinical care is another cause of relevance for CPT. The system also meets the need for tracking trends and identifying improvements, plus progression goals and scaling the value of healthcare services received by patients. The CPT coding system provides physicians throughout the United States with a consistent method for classifying and coding clinical procedures which in return provides a more efficient tool for recording and reporting task that were completed. Physicians, scholars and payors, have been dependent upon CPT to interconnect with other fellow associates, patients,

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.

The U.S. lags behind in implementing ICD-10 coding because of other healthcare concerns within our healthcare system. I believe that with the passing of the Affordable Care Act and the changes that it brought about, the major focus for healthcare providers was how to survive and adjust to the changes. From a government stand point, the main focus was getting the Act passed and working out all of the bugs within the system used for consumers to sign up for insurance. Due to this ICD-10 was kind of tabled for a later date. This was good for those providers that had not begun to update their systems.

I do agree with you it will have a great dramatic impact in healthcare. If the coding system is not used in a proper way it can affect many system that uses codes. When using ICD-10 yes this will help to be more specific when it comes to coding. Its not going to be very easy but its is going to help and change the way the coding system is being used so there won't be No mistakes. Yes, there is a big different between ICD-9 and ICD-10-CM but it can be also easy to learn it because it the revision to all the codes. I do believe the change is good because it just going to help us use a specific code when diagnoses.

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

The CPT code set is used to describe medical, surgical, and diagnostic services and is designed to communicate information about procedures with coders, accreditation organizations, and physicians, patients. The purpose of the codes is for financial, and administrative and analytical purposes. For example, if a physician performs a total abdominal colectomy Cpt code (44159) should be used. However, Cpt code (49000) exploratory laparotomy should not be used because it is included with code (44159) it is incorrect to bill for both. Medicare and Medicaid identify CPT codes as level 1 of the Healthcare Common Procedure Coding Systems. When using Category II codes the 5th character is identified by an alphabetical character. The CPT section includes information about modifiers, measures and the source, there is currently 11 CPT Category II codes. CPT Category III codes are used for data collection services and procedures. These codes are intended to be used in the approval process by the Food and Drug Administration

Train the physician, the physician assistant, and the billers to recognize key elements: ICD 10 codes, CPT codes, and verify correct patient’s demographics: name, address, and provider’s and insurance Group #/member ID #, address, phone numbers etc.

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

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.

In order for a smooth transition of the ICD-10 coding in hospitals and clinics, each position has a specific role to follow. Healthcare administrators and management will oversee the implementation process and educate all employees. One particular position that will need to stay on top of the transition process will be the information technology department. Their role will be to update all computers and software for ICD-10 coding. In addition to the frequent updates, IT department is responsible to convert all payment systems to the ICD-10 code changes. The front desk personnel should be familiar with the changes to forms, policies, and requirements for insurances. Acquiring this information from the patient can limit the amount of costly mistakes

Yes the time has arrives for all medical providers and practitioners must be in full compliance with the implementation of the ICD-10 coding system. What's so amazing is that many insurers offering assistance for the transition. According to Athena Health, they guarantee that their product will deliver a smooth transition by taking much of the preparation work off of the medical practice itself. Apparently they have devised a cloud-based service that is easier to use than the basic software programs commonly used. The costs for the transition is very expensive, In 2014, the Nachimson Advisers released a study estimating the cost of full implementation to ICD-10 for physician practices. In addition, The updated study estimated costs in

Similar to the previous study, the ICD-9-CM coding classification system was used for case definition of CT and NG cases. A male or female service member of the US Army with a first-time diagnosis (incidence case) of CT infection based on the ICD-9-CM codes 099.41 or 099.5, or with NG infection based on the ICD-9-CM codes 098.0x, 098.1x, 098.4x, or 098.8x) in either the first or second diagnostic position of a record of an outpatient or inpatient encounter of a medical record between January 1, 2006 and December 31, 2012 were initially selected. For both CT and NG case, the index date was the date of diagnosis of infection registered in the DMSS. Consequently, medical records (inpatient and outpatient) from all incident CT or NG cases selected

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,

You made an excellent point with regards to using ICD-9 coding. Coding can be challenging and errors are frequently made, which can skew data. I experienced this first hand when I was involved in the Congestive Heart Failure (CHF) telemonitoring program. The insurance company was extrapolating data from ICD codes to determine potential candidate to be enrolled in the program, and come to find out those individuals that had an ICD-9-CM Diagnosis Code 428 for CHF, did not really have CHF.