Survey of Medical Insurance pp ch04

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  • Teaching Notes:   Have students define all key terms as an assignment. Then, in class, ask each student to define one key term aloud.   Optional assignment: Have students do an Internet search of one key term and write a short paragraph describing what they learned about that term from looking at a few websites.
  • Teaching Notes:   Have students define all key terms as an assignment. Then, in class, ask each student to define one key term aloud.   Optional assignment: Have students do an Internet search of one key term and write a short paragraph describing what they learned about that term from looking at a few websites.
  • Learning Outcome: 4.1 Discuss the purpose of the ICD-9-CM. Pages: 128-129 Teaching Notes:   Ask your students to explain why they think it is important for the CMS to release ICD-9-CM updates two times per year.
  • Learning Outcome: 4.2 Compare ICD-9-CM Volumes 1, 2, and 3. Pages: 129-130 Teaching Notes:   Have your students explain the reason that the Alphabetic Index is used before the Tabular List.
  • Learning Outcome: 4.3 Summarize the structure, content, and the five conventions that are followed in the Alphabetic Index. Pages: 130-133 Teaching Notes:   Provide your students with an example of how the Alphabetic Index is organized. (See the example using the term wrist fracture on page 130 as a reference.)
  • Learning Outcome: 4.3 Summarize the structure, content, and the five conventions that are followed in the Alphabetic Index. Pages: 130-133 Teaching Notes:   Provide your students with an example of how main terms and subterms are linked. (See the blindness and color blindness example of page 130 as a reference.)
  • Learning Outcome: 4.3 Summarize the structure, content, and the five conventions that are followed in the Alphabetic Index. Pages: 130-133 Teaching Notes:   Provide your students with some examples of eponyms. (For example, Hodgkin’s disease.)
  • Learning Outcome: 4.3 Summarize the structure, content, and the five conventions that are followed in the Alphabetic Index. Pages: 130-133 Teaching Notes:   Discuss each of the five conventions that apply to using the Alphabetic Index correctly with the class.
  • Learning Outcome: 4.4 S ummarize the structure, content, and ten conventions that are followed in the Tabular List. Pages: 133-138 Teaching Notes:   Look over the chapters of the Tabular List (found in Table 4.1) with your class.
  • Learning Outcome: 4.4 S ummarize the structure, content, and ten conventions that are followed in the Tabular List. Pages: 133-138 Teaching Notes:   Use the example of Tabular List entries in Figure 4.2 to show students the difference between a category, subcategory, and subclassification.
  • Learning Outcome: 4.4 S ummarize the structure, content, and ten conventions that are followed in the Tabular List. Pages: 133-138 Teaching Notes:   Provide the students with an example of when the NOS abbreviation might be used. (See the example of leg NOS on page 137.)
  • Learning Outcome: 4.4 S ummarize the structure, content, and ten conventions that are followed in the Tabular List. Pages: 133-138 Teaching Notes:   Discuss each of the ten conventions that apply to using the Tabular List correctly with the class.
  • Learning Outcome: 4.4 S ummarize the structure, content, and ten conventions that are followed in the Tabular List. Pages: 133-138 Teaching Notes:   Discuss each of the ten conventions that apply to using the Tabular List correctly with the class.
  • Learning Outcome: 4.5 Recognize the chapters that make up the Tabular List. Pages: 138-144 Teaching Notes:   Examine the breakdown of the Chapters in the Tabular List with your class.
  • Learning Outcome: 4.5 Recognize the chapters that make up the Tabular List. Pages: 138-144 Teaching Notes:   Examine the breakdown of the Chapters in the Tabular List with your class.
  • Learning Outcome: 4.5 Recognize the chapters that make up the Tabular List. Pages: 138-144 Teaching Notes:   Examine the breakdown of the Chapters in the Tabular List with your class.
  • Learning Outcome: 4.6 Identify the purpose and correct use of V codes and of E codes. Pages: 144-146 Teaching Notes:   Provide your students with examples of patient conditions or injuries, and ask them if a V code or an E code would apply.
  • Learning Outcome: 4.6 Identify the purpose and correct use of V codes and of E codes. Pages: 144-146 Teaching Notes:   Ask your students to explain the difference between an adverse effect and poisoning. (Adverse effects are a patient’s unintentional, harmful reaction to a proper dosage of a drug, while poisoning refers to the medical result of the incorrect use of a substance.)
  • Learning Outcome: 4.7 List the five steps in the process of assigning diagnosis codes. Pages: 146-149 Teaching Notes:   Practice assigning diagnosis codes with your students using the correct five-step process.
  • Learning Outcome: 4.7 List the five steps in the process of assigning diagnosis codes. Pages: 146-149 Teaching Notes:   Have your students give examples of a coexisting condition.
  • Learning Outcome: 4.8 Describe and provide examples of three key coding guidelines that are included in the ICD-9-CM Official Guidelines for Coding and Reporting . Pages: 149-155 Teaching Notes:   Discuss the three key coding guidelines for using the ICD-9-CM Official Guidelines for Coding and Reporting with the class. (See slide 4-24.)
  • Learning Outcome: 4.8 Describe and provide examples of three key coding guidelines that are included in the ICD-9-CM Official Guidelines for Coding and Reporting. Pages: 149-155 Teaching Notes:   Discuss the difference between an acute and a chronic illness or condition. (An acute illness or condition features severe symptoms and a short duration, while a chronic illness or condition has a long duration.)
  • Learning Outcome: 4.9 Explain five differences and two similarities between ICD-10-CM and ICD-9-CM. Pages: 155-159 Teaching Notes:   Examine the differences and the similarities between the ICD-9-CM and the ICD-10-CM with your class. (Differences include chapter structure, chapter order, code structure, increased specificity and clinical detail, and excludes notes, while similarities include the two major sections of the code set.)
  • Survey of Medical Insurance pp ch04

    1. 1. 4 Diagnostic Coding: Introduction to ICD-9-CM and ICD-10-CM
    2. 2. Learning Outcomes <ul><li>When you finish this chapter, you will be able to: </li></ul><ul><li>4.1 Discuss the purpose of the ICD-9-CM. </li></ul><ul><li>4.2 Compare ICD-9-CM Volumes 1, 2, and 3. </li></ul><ul><li>4.3 Summarize the structure, content, and the five conventions that are followed in the Alphabetic Index. </li></ul><ul><li>4.4 Summarize the structure, content, and ten conventions that are followed in the Tabular List. </li></ul><ul><li>4.5 Recognize the chapters that make up the Tabular List. </li></ul><ul><li>4.6 Identify the purpose and correct use of V codes and of E codes. </li></ul>4-2
    3. 3. Learning Outcomes (Continued) <ul><li>When you finish this chapter, you will be able to: </li></ul><ul><li>4.7 List the five steps in the process of assigning diagnosis codes. </li></ul><ul><li>4.8 Describe and provide examples of three key coding guidelines that are included in the ICD-9-CM Official Guidelines for Coding and Reporting . </li></ul><ul><li>4.9 Explain five differences and two similarities between ICD-10-CM and ICD-9-CM. </li></ul>4-3
    4. 4. Key Terms <ul><li>acute </li></ul><ul><li>addenda </li></ul><ul><li>adverse effect </li></ul><ul><li>Alphabetic Index </li></ul><ul><li>category </li></ul><ul><li>chief complaint (CC) </li></ul><ul><li>chronic </li></ul><ul><li>coexisting condition </li></ul><ul><li>combination code </li></ul><ul><li>convention </li></ul><ul><li>crosswalk </li></ul>4-4 <ul><li>diagnostic statement </li></ul><ul><li>E code </li></ul><ul><li>eponym </li></ul><ul><li>etiology </li></ul><ul><li>ICD-9-CM </li></ul><ul><li>ICD-9-CM Official Guidelines for Coding and Reporting </li></ul><ul><li>ICD-10-CM </li></ul><ul><li>late effect </li></ul><ul><li>main term </li></ul>
    5. 5. Key Terms (Continued) <ul><li>manifestation </li></ul><ul><li>NEC (not elsewhere classified) </li></ul><ul><li>NOS (not otherwise specified) </li></ul><ul><li>primary diagnosis </li></ul><ul><li>subcategory </li></ul><ul><li>subclassification </li></ul><ul><li>subterm </li></ul><ul><li>supplementary term </li></ul><ul><li>Table of Drugs and Chemicals </li></ul>4-5 <ul><li>Tabular List </li></ul><ul><li>unspecified </li></ul><ul><li>V code </li></ul>
    6. 6. 4.1 The ICD-9-CM <ul><li>The diagnosis codes used in the United States are based on the International Classification of Diseases (ICD) </li></ul><ul><li>The U.S. version of the ninth edition is called the ICD-9’s Clinical Modification, or ICD-9-CM </li></ul><ul><ul><li>Used to code and classify morbidity data from patient medical records, physician offices, and surveys </li></ul></ul><ul><li>Addenda— updates to the ICD-9-CM </li></ul>4-6
    7. 7. 4.2 Organization of the ICD-9-CM <ul><li>The ICD-9-CM has three parts (or volumes): </li></ul><ul><ul><li>Diseases and Injuries: Tabular List—Volume 1: Tabular List— section of the ICD-9-CM listing diagnosis codes numerically </li></ul></ul><ul><ul><li>Diseases and Injuries: Alphabetic Index—Volume 2: Alphabetic Index— section of the ICD-9-CM listing diseases and injuries with corresponding diagnosis codes alphabetically </li></ul></ul><ul><ul><li>Procedures: Tabular List and Alphabetic Index—Volume 3: covers procedures chiefly in hospitals </li></ul></ul>4-7
    8. 8. 4.3 The Alphabetic Index <ul><li>The Alphabetic Index: </li></ul><ul><ul><li>Contains all the medical terms in the Tabular List classifications </li></ul></ul><ul><ul><li>Organized by the condition, not body part </li></ul></ul><ul><ul><li>Medical term describing the condition for which a patient is receiving care is located in the physician’s diagnostic statement— a physician’s description of the main reason for a patient’s encounter </li></ul></ul>4-8
    9. 9. 4.3 The Alphabetic Index (Condition) <ul><li>Main term— word that identifies a disease or condition in the ICD-9-CM Alphabetic Index </li></ul><ul><li>Subterm— word or phrase that describes a main term in the ICD-9-CM Alphabetic Index </li></ul><ul><li>Etiology— cause or origin of a disease </li></ul><ul><li>Supplementary term— nonessential word or phrase that helps define a code in the ICD-9-CM </li></ul><ul><li>Convention— typographic techniques or standard practices that provide visual guidelines for understanding printed material </li></ul>4-9
    10. 10. 4.3 The Alphabetic Index (Condition) <ul><li>NEC (not elsewhere classified)— indicates the code to use when an illness or condition cannot be placed in any other category </li></ul><ul><li>Manifestation— characteristic sign or symptom of a disease </li></ul><ul><li>Combination code— single code that classifies both the etiology and the manifestation of an illness or injury </li></ul><ul><li>Eponym— name or phrase formed from or based on a person’s name </li></ul>4-10
    11. 11. 4.3 The Alphabetic Index (Continued) <ul><li>Five conventions apply to using the Alphabetic Index correctly: </li></ul><ul><ul><li>Turnover lines are indented farther to the right than subterms </li></ul></ul><ul><ul><li>See cross-references lead the coder to another main term; see also suggest additional possible key terms </li></ul></ul><ul><ul><li>Notes provide information on code selection </li></ul></ul><ul><ul><li>The abbreviation NEC appears with main terms for which no specific code exists </li></ul></ul><ul><ul><li>Some conditions may require two codes </li></ul></ul>4-11
    12. 12. 4.4 The Tabular List <ul><li>The Tabular List: </li></ul><ul><ul><li>Diseases and injuries are organized into chapters according to etiology or body system </li></ul></ul><ul><ul><li>Supplementary codes and appendices cover other special situations </li></ul></ul><ul><ul><li>Each chapter is divided into sections with titles that indicate the types of related diseases or conditions they cover </li></ul></ul>4-12
    13. 13. 4.4 The Tabular List (Continued) <ul><li>Category— three-digit code that covers a single disease or related condition </li></ul><ul><li>Subcategory— four-digit subdivision of a category </li></ul><ul><li>Subclassification— five-digit subdivision of a subcategory </li></ul>4-13
    14. 14. 4.4 The Tabular List (Continued) <ul><li>NOS (not otherwise specified)— indicates the code to use when no information is available for assigning the illness or condition a more specific code </li></ul><ul><li>Unspecified— incompletely described condition that must be coded with an unspecified ICD code </li></ul>4-14
    15. 15. 4.4 The Tabular List (Continued) <ul><li>Ten conventions are used in the Tabular List: </li></ul><ul><ul><li>Fifth-digit requirement symbol </li></ul></ul><ul><ul><li>Includes and excludes notes </li></ul></ul><ul><ul><li>Colons in notes </li></ul></ul><ul><ul><li>Parentheses around supplementary terms </li></ul></ul><ul><ul><li>Brackets around supplementary synonyms, alternative wording, or explanations </li></ul></ul><ul><ul><li>Braces to group related terms </li></ul></ul><ul><ul><li>Lozenge for nonWHO codes </li></ul></ul>4-15
    16. 16. 4.4 The Tabular List (Continued) <ul><li>Ten conventions are used in the Tabular List (continued): </li></ul><ul><ul><li>The abbreviation NOS to indicate the code to use when a condition is not completely described, and the abbreviation NEC for the code to use when the diagnosis does not match any other available code </li></ul></ul><ul><ul><li>Bullet (●) for new codes or entries, single triangle (►) or facing triangles (►◄) for new or revised descriptions </li></ul></ul><ul><ul><li>Phrases for multiple code requirements: codes that are not used as primary appear in italics and are usually followed by an instruction to code first underlying disease or use an additional code </li></ul></ul>4-16
    17. 17. 4.5 Tabular List of Chapters <ul><li>The Chapters of the Tabular List: </li></ul><ul><ul><li>Infectious and Parasitic Diseases—Codes 001–139 </li></ul></ul><ul><ul><li>Neoplasms—Codes 140–239 </li></ul></ul><ul><ul><li>Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders—Codes 240–279 </li></ul></ul><ul><ul><li>Diseases of the Blood and Blood-Forming Organs—Codes 280–289 </li></ul></ul><ul><ul><li>Mental Disorders—Codes 290–319 </li></ul></ul><ul><ul><li>Diseases of the Nervous System and Sense Organs—Codes 320–389 </li></ul></ul><ul><ul><li>Diseases of the Circulatory System—Codes 390–459 </li></ul></ul><ul><ul><li>Diseases of the Respiratory System—Codes 460–519 </li></ul></ul>4-17
    18. 18. 4.5 Tabular List of Chapters (Continued) <ul><li>The Chapters of the Tabular List (Continued): </li></ul><ul><ul><li>Diseases of the Digestive System—Codes 520–579 </li></ul></ul><ul><ul><li>Diseases of the Genitourinary System—Codes 580–629 </li></ul></ul><ul><ul><li>Complications of Pregnancy, Childbirth, and the Puerperium—Codes 630–677 </li></ul></ul><ul><ul><li>Diseases of the Skin and Subcutaneous Tissue—Codes 680–709 </li></ul></ul><ul><ul><li>Diseases of the Musculoskeletal System and Connective Tissue—Codes 710–739 </li></ul></ul><ul><ul><li>Congenital Anomalies—Codes 740–759 </li></ul></ul>4-18
    19. 19. 4.5 Tabular List of Chapters (Continued) <ul><li>The Chapters of the Tabular List (Continued): </li></ul><ul><ul><li>Certain Conditions Originating in the Perinatal Period—Codes 760–779 </li></ul></ul><ul><ul><li>Symptoms, Signs, and Ill-Defined Conditions—Codes 780–799 </li></ul></ul><ul><ul><li>Injury and Poisoning—Codes 800–999 </li></ul></ul>4-19
    20. 20. 4.6 V Codes and E Codes <ul><li>V Code— alphanumeric ICD code that identifies factors influencing health status and encounters not due to illness or injury </li></ul><ul><ul><li>Use for healthy patients to receive routine service, for therapeutic encounters, for a problem that is not currently affecting the patient’s condition, and for preoperative evaluations </li></ul></ul><ul><li>E Code —alphanumeric ICD code for an external cause of injury or poisoning </li></ul><ul><ul><li>Never used as primary codes </li></ul></ul>4-20
    21. 21. 4.6 V Codes and E Codes (Continued) <ul><li>Adverse effect— patient’s unintentional, harmful reaction to a proper dosage of a drug </li></ul><ul><li>Table of Drugs and Chemicals— reference listing of drugs and chemicals in the ICD-9-CM Alphabetic Index </li></ul>4-21
    22. 22. 4.7 Coding Steps <ul><li>The correct process for assigning accurate diagnosis codes has five steps: </li></ul><ul><ul><li>Step 1 – Review complete medical documentation </li></ul></ul><ul><ul><li>Step 2 – Abstract the medical conditions from the visit documentation </li></ul></ul><ul><ul><li>Step 3 – Identify the main term for each condition </li></ul></ul><ul><ul><li>Step 4 – Locate the main terms in the Alphabetic Index </li></ul></ul><ul><ul><li>Step 5 – Verify the code in the Tabular List </li></ul></ul>4-22
    23. 23. 4.7 Coding Steps (Continued) <ul><li>Chief complaint (CC)— patient’s description of the symptoms or reasons for seeking medical care </li></ul><ul><li>Primary diagnosis— represents the patient’s major illness or condition for an encounter </li></ul><ul><li>Coexisting condition— additional illness that either affects the primary illness or is also treated during an encounter </li></ul>4-23
    24. 24. 4.8 Official Coding Guidelines <ul><li>ICD-9-CM Official Guidelines for Coding and Reporting — American Hospital Association publication that provides rules for selecting and sequencing diagnosis codes </li></ul><ul><li>Includes three key coding guidelines: </li></ul><ul><ul><li>Code the primary diagnosis first, followed by current coexisting conditions </li></ul></ul><ul><ul><li>Code to the highest degree of certainty, never coding inconclusive, rule-out diagnoses </li></ul></ul><ul><ul><li>Code to the highest level of specificity, using fifth digits or fourth digits when available </li></ul></ul>4-24
    25. 25. 4.8 Official Coding Guidelines (Continued) <ul><li>Acute— illness or condition featuring severe symptoms and a short duration </li></ul><ul><li>Chronic —illness or condition with a long duration </li></ul><ul><li>Late effect— condition that remains after an acute illness or injury </li></ul>4-25
    26. 26. 4.9 Introducing ICD-10-CM <ul><li>ICD-10-CM— abbreviated title of International Classification of Diseases , Tenth Revision, Clinical Modification </li></ul><ul><ul><li>Differences from ICD-9-CM include chapter structure, chapter order, code structure, increased specificity and clinical detail, and excludes notes </li></ul></ul><ul><li>Crosswalk— map of codes for same or similar classifications under two coding systems </li></ul>4-26

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