Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 1
The Rationale for and...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
2
Lesson 1.1: The Rationale for...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
3
Lesson 1.1: The Rationale for...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
4
Background of Coding
 What i...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
5
Background of Coding
 Nomenc...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
6
History of Coding
 1893: Ber...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
7
History of Coding
 1993: ICD...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
8
History of Coding
 ICD-9-CM ...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
9
History of Coding
 Developme...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
10
Preparation for Transition t...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
11
Preparation for Transition t...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
12
Coding Organizations and
Cre...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
13
Coding Organizations and
Cre...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
14
Coding Organizations and
Cre...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
15
Coding Organizations and
Cre...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
16
Coding Organizations and
Cre...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
17
Coding Ethics
 AHIMA and AA...
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18
Coding Ethics
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
19
Compliance
 Follow the rule...
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20
Compliance
 Make sure you a...
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21
Confidentiality
 Covered in...
Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
22
QUESTIONS
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MO230 Chapter 001

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  • Medical coding consists of translating diagnoses and procedures into numbers for the purpose of statistically capturing data.
  • A nomenclature is a system of names that are used as preferred terminology (in this case, for diseases and procedures). Classification systems group together similar items for easy storage and retrieval. The ICD-10-CM classification system is a closed system that comprises diseases, injuries, surgeries, and procedures. In a closed classification system a disease, condition, or procedure can only be classified in one place.
  • ICD-9-CM, a publication of the U.S. Department of Health and Human Services, consists of 3 volumes.
  • ICD-10-CM will replace ICD-9-CM, which has been in use for 30 years. The final rule for adoption of ICD-10-CM and ICD-10-PCS was released in January 2009. ICD-10 Tabular Volume was published in 1992. ICD-10 Instructional Volume was published in 1993. ICD-10 Alphabetic Index was published in 1994.
  • ICD-9-CM Coordination and Maintenance Committee meets twice a year. Upon full implementation of ICD-10-CM/PCS this will become the ICD-10 Coordination and Maintenance Committee. 2 Federal agencies are responsible for maintenance of ICD-9-CM: NCHS – Classification of diagnoses CMS – Classification of procedures
  • Along with above knowledge, also educate on the following: Structure change Disease classification Definitions Guidelines ICD-10-PCS
  • Most coders take certification examinations to earn credentials and become members of a professional organization.
  • See Table 1-2 in this chapter to see how many CEUs are required per year.
  • Please see Figures 1-1 and 1-2.
  • MO230 Chapter 001

    1. 1. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chapter 1 The Rationale for and History of Coding
    2. 2. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 Lesson 1.1: The Rationale for and History of Coding  Describe the application of coding.  Define nomenclature and classification.  Identify the historical timeline of coding.  Explain the difference between ICD-9-CM and ICD- 10-CM.  Delineate coder training needs for transitioning to ICD-10-CM.  Describe the different coding organizations and credentials.
    3. 3. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 Lesson 1.1: The Rationale for and History of Coding  Recognize the importance of the Standards of Ethical Coding.  Define compliance as it relates to coding.  Explain confidentiality as it relates to coding.
    4. 4. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Background of Coding  What is coding, and what are its applications?  International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM & ICD-10-PCS)  Medicare Severity Diagnosis-Related Groups (MS-DRGs)
    5. 5. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 Background of Coding  Nomenclature  Classification  Types of  History of
    6. 6. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 History of Coding  1893: Bertillon’s Classification of Causes of Death  1898: Adopted by the American Public Health Association  World Health Organization (WHO)  International Classification of Causes of Death  1977: Clinical Modifications (CMs) for U.S.
    7. 7. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 History of Coding  1993: ICD-10 published by the WHO  In use in other countries  Alphanumeric system  Implementation in the U.S. slated for October 2014
    8. 8. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 History of Coding  ICD-9-CM updated twice a year  Federal Register publication of updates  See www.cms.gov  Current coding tools are a must!
    9. 9. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 History of Coding  Development & maintenance of guidelines:  National Center for Health Statistics (NCHS)  Centers for Medicare and Medicaid Services (CMS)  American Hospital Association (AHA)  American Health Information Management Association (AHIMA)
    10. 10. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Preparation for Transition to ICD-10- CM  Differences between ICD-10-CM & ICD-9-CM  Increase in the number of codes and code categories Change from numeric to alphanumeric Increase in digits from 5 to 7 Increase from 17 chapters to 21 chapters
    11. 11. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Preparation for Transition to ICD-10-CM  Coders must have in-depth knowledge of  Anatomy and physiology  Medical terminology  Operative reports  ICD-10-PCS definitions
    12. 12. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Coding Organizations and Credentials  Where do coders work?  Hospitals  Physician offices  Outpatient surgical centers  Long-term care facilities  Insurance companies  Prisons  Government agencies
    13. 13. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Coding Organizations and Credentials  American Health Information Management Association (AHIMA) Credentials:  CCA Certified Coding Associate  CCS Certified Coding Specialist  CCS-P Certified Coding Specialist– Physician-Based  RHIT Registered Health Information Technician  RHIA Registered Health Information Administrator
    14. 14. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Coding Organizations and Credentials  American Academy of Professional Coders (AAPC) Credentials:  CPC Certified Professional Coder  CPC-H Certified Professional Coder– Hospital-Based  CPC-P Certified Professional Coder– Payer-Based
    15. 15. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Coding Organizations and Credentials  Certification examinations  Keeping coding knowledge current  Continuing education units (CEUs)  Minimums are required to maintain certification
    16. 16. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Coding Organizations and Credentials
    17. 17. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Coding Ethics  AHIMA and AAPC have standards for ethical coding  Examples:  Coding professionals should adhere to coding guidelines  They should only assign and report codes that are supported by physician documentation  They should maintain and enhance coding skills
    18. 18. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Coding Ethics
    19. 19. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Compliance  Follow the rules!  Who makes the rules?  CMS  State agencies  Joint Commission  Increase in compliance programs  Health Insurance Portability and Accountability Act of 1996 (HIPAA)  Increase in compliance officers
    20. 20. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Compliance  Make sure you and your department are in compliance  Steps to ensure compliance  Have a coding compliance plan  What should be in the plan?
    21. 21. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Confidentiality  Covered in:  Patient Bill of Rights  HIPAA  Common sense/need-to-know approach
    22. 22. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 QUESTIONS

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