Medical Coding Bootcamp Agenda and Overview
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The document summarizes a presentation on medical coding given by Melanie Endicott. The presentation covered topics including health information management, common medical code sets like ICD-10, CPT, and HCPCS, and how accurate clinical documentation is linked to proper medical coding and DRG assignment. The goal was to provide an introduction to medical coding for attendees.
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Medical Coding Bootcamp Agenda and Overview
- 1. mHealth Israel 12/13/2020 ©AHIMA 2020 1 mHealth Israel December 13th, 2020 Medical Coding Bootcamp Melanie Endicott, MBA/HCM, RHIA, CDIP, CHDA, CPHI, CCS, CCS-P, FAHIMA American Health Information Management Association Senior Director, International Education and Training Medical Coding Bootcamp Agenda • About AHIMA • Introduction to Health Information Management (HIM) • Healthcare Code Sets, Clinical Terminologies, and Classification Systems • International Classification of Diseases (ICD) • Current Procedural Terminology (CPT) • Healthcare Common Procedure Coding System (HCPCS) • Systemized Nomenclature of Medicine Coding Terms (SNOMED CT) • And many more… 2 | ahima.org | © 2020 Melanie Endicott 1 2
- 2. mHealth Israel 12/13/2020 ©AHIMA 2020 2 About AHIMA Medical Coding Bootcamp Empowering people to impact health 4 | ahima.org | © 2020 Melanie Endicott A world where trusted information transforms health and healthcare by connecting people, systems, and ideas 3 4
- 3. mHealth Israel 12/13/2020 ©AHIMA 2020 3 Medical Coding Bootcamp 5 | ahima.org | © 2020 Melanie Endicott Medical Coding Bootcamp We believe… • health information is the most powerful currency for change in the healthcare ecosystem • our mission drives us to create lasting change in the health of the individuals, organizations, and societies around the globe • consumers of healthcare are the ultimate owners and beneficiaries of their own data • people will always be central in harnessing the power of information to tear down barriers to better health 6 | ahima.org | © 2020 Melanie Endicott 5 6
- 4. mHealth Israel 12/13/2020 ©AHIMA 2020 4 Introduction to Health Information Management Medical Coding Bootcamp What is Health Information (HI)? • Health information is the data related to a person’s medical history, including symptoms, diagnoses, procedures, and outcomes. • Health information records include patient histories, lab results, x-rays, clinical information, and notes. • A patient’s health information can be viewed individually, to see how a patient’s health has changed; it can also be viewed as a part of a larger data set to understand how a population’s health has changed, and how medical interventions can change health outcomes. 8 | ahima.org | © 2020 Melanie Endicott 7 8
- 5. mHealth Israel 12/13/2020 ©AHIMA 2020 5 Medical Coding Bootcamp Health Information Management (HIM) • HIM is the profession dedicated to the effective management of patient information and healthcare data needed to deliver high-quality treatment and care to the public. • HIM professionals who perfect their technical skills become experts in health data collection, data abstraction, enhanced coding and monitoring, while maintaining the highest standards of data integrity, confidentiality, and security. 9 | ahima.org | © 2020 Melanie Endicott Medical Coding Clinical Documentation Integrity Healthcare Privacy and Security Health Data Analytics More than 40 job categories and 200 job titles Medical Coding Bootcamp Health Information Technology (HIT) • Health information technology refers to the framework used to manage health information, and the exchange of health information in a digital format. • HIT professionals are focused on the technical side of managing health information, working with software and hardware used to manage and store patient data. • HIT professionals provide support for EHRs and other information systems used to secure health information. • HIM and HIT professionals often have the same skill sets • HIM and HIT are intertwined and inextricably linked 10 | ahima.org | © 2020 Melanie Endicott 9 10
- 6. mHealth Israel 12/13/2020 ©AHIMA 2020 6 Medical Coding Bootcamp Where Do HIM Professionals Work? 11 | ahima.org | © 2020 Melanie Endicott Acute Care Governmental and Regulatory Agencies Outpatient Care Long-term Care Behavioral Health Vendors Payers Healthcare Code Sets, Clinical Terminologies, and Classification Systems 11 12
- 7. mHealth Israel 12/13/2020 ©AHIMA 2020 7 Medical Coding Bootcamp 13 | ahima.org | © 2020 Melanie Endicott So Many Codes… Medical Coding Bootcamp What is Coding? 14 | ahima.org | © 2020 Melanie Endicott Classifying a narrative description of a disease, condition or procedure into a quantifiable representation or code number Code numbers are used to facilitate statistical comparison of disease processes and services The supporting documentation and content within the health record enables a coding professional to assign appropriate codes to the disease processes and treatment provided 13 14
- 8. mHealth Israel 12/13/2020 ©AHIMA 2020 8 15 | ahima.org | © 2020 Melanie Endicott Facilitates retrieval of information for… Research Accreditation Services planning Benchmarking Reimbursement Medical Coding Bootcamp 16 | ahima.org | © 2020 Melanie Endicott Code(s) Assigned U07.1 COVID-19 Clinical Documentation Accurate Reporting 15 16
- 9. mHealth Israel 12/13/2020 ©AHIMA 2020 9 Medical Coding Bootcamp International Classification of Diseases (ICD) • 1860: Florence Nightingale • 1893: Bertillon Classification of Causes of Death • 1898: American Public Health Association recommended revising every 10 years • 1948: World Health Organization assumed responsibility for updates • ICD is the most widely use statistical classification system for diseases in the world • 10th edition used by most countries • 11th edition launches January 1, 2022 17 | ahima.org | © 2020 Melanie Endicott Medical Coding Bootcamp ICD-10 provides defined codes for the purposes of: • Classifying morbidity and mortality information for statistical purposes • Indexing hospital records by disease and operations • Reporting diagnoses and procedures for reimbursement • Storing and retrieving data • Determining patterns of care among healthcare providers • Analyzing payments for health services • Performing epidemiological studies, clinical trials, and clinical research • Measuring quality, safety, and efficacy of care • Designing payment systems • Setting health policy • Monitoring resource utilization • Implementing operational and strategic plans • Designing healthcare delivery systems • Improving clinical, financial, and administrative performance • Preventing and detecting healthcare fraud and abuse • Tracking public health and risks 18 | ahima.org | © 2020 Melanie Endicott 17 18
- 10. mHealth Israel 12/13/2020 ©AHIMA 2020 10 Coding & CDI: Best Practices 19 | ahima.org | © 2020 Melanie Endicott ICD-10 – over 14,000 codes ICD-10-AM – over 22,000 codes ICD-10-CM – over 69,000 codes ICD-10 ICD-10-AM ICD-10-CM Midcervical fracture of the left femur Code Set Code Description ICD-10 S72.0 Fracture of neck of femur ICD-10-AM S72.04 Fracture of midcervical section of femur ICD-10-CM S72.032A Displaced midcervical fracture of left femur, initial encounter for closed fracture 19 20
- 11. mHealth Israel 12/13/2020 ©AHIMA 2020 11 Medical Coding Bootcamp ICD-10-CM • International Classification of Diseases, 10th Revision, Clinical Modification • Developed by the United States, and utilized in several other countries • Maintained by the National Center for Health Statistics (NCHS) • Updated annually on October 1 • Classifies diagnoses, health-related conditions, and statuses for all types of patient encounters 21 | ahima.org | © 2020 Melanie Endicott 21 22
- 12. mHealth Israel 12/13/2020 ©AHIMA 2020 12 ICD-10-CM https://www.cms.gov/Medicare/Coding/ICD10 Medical Coding Bootcamp ICD-10-PCS • International Classification of Diseases, 10th Revision, Procedure Coding System • Developed by the United States, and utilized in a few other countries • Maintained by the Centers for Medicare and Medicaid Services (CMS) • Updated annually on October 1 • Classifies procedures for inpatient encounters 24 | ahima.org | © 2020 Melanie Endicott 23 24
- 13. mHealth Israel 12/13/2020 ©AHIMA 2020 13 ICD-10-PCS https://www.cms.gov/Medicare/Coding/ICD10 Final ICD-10-PCS Code: 027034Z 25 26
- 14. mHealth Israel 12/13/2020 ©AHIMA 2020 14 ICD-11 https://icd.who.int/browse11/l-m/en Medical Coding Bootcamp Current Procedural Terminology (CPT®) 28 | ahima.org | © 2020 Melanie Endicott • Developed by American Medical Association (AMA) • Updated annually on January 1 • United States and several other countries use CPT for reporting physician services • 6 Sections: 1. Evaluation and Management 2. Anesthesia 3. Surgery 4. Radiology 5. Pathology & Laboratory 6. Medicine 27 28
- 15. mHealth Israel 12/13/2020 ©AHIMA 2020 15 CPT® https://www.ama-assn.org/ Medical Coding Bootcamp Healthcare Common Procedure Coding System (HCPCS) • Developed by the Centers for Medicare and Medicaid Services (CMS) • Standardize medical procedures, supplies, products, and services • Updated quarterly • Examples of codes: • Dental procedures • Durable medical equipment • Drugs administered • Temporary codes 30 | ahima.org | © 2020 Melanie Endicott 29 30
- 16. mHealth Israel 12/13/2020 ©AHIMA 2020 16 HCPCS https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets Medical Coding Bootcamp Systemized Nomenclature of Medicine Coding Terms (SNOMED CT) • Owned by SNOMED International • Comprehensive reference terminology designed to capture clinical information • Standard for entry of structured data in certified EHR systems • Enables interoperability and clinical decision support functionality 32 | ahima.org | © 2020 Melanie Endicott 31 32
- 17. mHealth Israel 12/13/2020 ©AHIMA 2020 17 Medical Coding Bootcamp SNOMED CT Cross Maps • Enable SNOMED CT to effectively reference other terminologies and classifications • Maps allow data collected for one purpose to be used for another purpose • Map examples: • SNOMED CT to ICD-10 • SNOMED CT to ICD-10-CM • SNOMED CT to ICD-11 33 | ahima.org | © 2020 Melanie Endicott SNOMED CT https://www.snomed.org/ 33 34
- 18. mHealth Israel 12/13/2020 ©AHIMA 2020 18 Medical Coding Bootcamp National Drug Codes (NDCs) • Product identifiers maintained and approved by the Food and Drug Administration (FDA) • Human drugs • Biologics • Veterinary drugs • Uses: • Billing & reimbursement • Determine whether a product is marketed without an approved application • Identify the ingredients of marketed drugs • Use as a resource for the inspection of drug facilities • Public health protection 35 | ahima.org | © 2020 Melanie Endicott https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory 35 36
- 19. mHealth Israel 12/13/2020 ©AHIMA 2020 19 Medical Coding Bootcamp RxNorm • Developed by National Library of Medicine (NLM) • Provides normalized names and unique identifiers for clinical drugs and drug delivery devices • Supports semantic interoperation between multiple drug terminologies • Mappings: NDC, HCPCS 37 | ahima.org | © 2020 Melanie Endicott RxNorm https://www.nlm.nih.gov/research/umls/rxnorm/overview.html 37 38
- 20. mHealth Israel 12/13/2020 ©AHIMA 2020 20 Medical Coding Bootcamp Current Dental Terminology (CDT) • Dental procedure code set • Developed by the American Dental Association (ADA) • Four sections: 1. Code on Dental Procedures and Nomenclature 2. CDT Code Changes Mark-Up 3. Alphabetic Index to the CDT Code 4. Numeric Index to the CDT Code • Relationships with SNOMED CT and HCPCS 39 | ahima.org | © 2020 Melanie Endicott CDT Procedure Code Nomenclature Descriptor D0210 Intraoral – complete series of radiographic images A radiographic survey of the whole mouth, usually consisting of 14-22 periapical and posterior bitewing images intended to display the crowns and roots of all teeth, periapical areas, and alveolar bone. https://www.ada.org/en/publications/cdt 39 40
- 21. mHealth Israel 12/13/2020 ©AHIMA 2020 21 Medical Coding Bootcamp Diagnostic and Statistical Manual of Mental Disorders (DSM) • Developed by the American Psychiatric Association (APA) • Standard classification of mental disorders • Assists clinicians in the diagnosis of mental disorders in patients • Maps to ICD-10-CM, ICD-11, and SNOMED CT 41 | ahima.org | © 2020 Melanie Endicott DSM https://www.psychiatry.org/psychiatrists/practice/dsm 41 42
- 22. mHealth Israel 12/13/2020 ©AHIMA 2020 22 Medical Coding Bootcamp Logical Observation Identifiers, Names, and Codes (LOINC) • Developed by Regenstrief Institute • Provides a universal set of identifiers for health measurements, observations, and documents • Uses: • Laboratory • Clinical • Nursing • Radiology 43 | ahima.org | © 2020 Melanie Endicott LOINC https://www.degruyter.com/view/journals/labm/43/6/article-p359.xml?language=en 43 44
- 23. mHealth Israel 12/13/2020 ©AHIMA 2020 23 Medical Coding Bootcamp International Classification of Functioning, Disability, and Health (ICF) • Developed by WHO • Provides a unified and standard language for the description of health and health-related states • Used with all people, not just those with a disability • Relationships with ICD-11, ICHI and EHRs 45 | ahima.org | © 2020 Melanie Endicott ICF https://www.who.int/standards/classifications/international- classification-of-functioning-disability-and-health 45 46
- 24. mHealth Israel 12/13/2020 ©AHIMA 2020 24 ICF https://www.who.int/standards/classifications/international- classification-of-functioning-disability-and-health Application of Terminologies and Classification Systems in Healthcare 47 48
- 25. mHealth Israel 12/13/2020 ©AHIMA 2020 25 Linking Clinical Documentation to Coding & DRG Assignment 740 MS-DRGs Pt Variables (e.g., Age, Gender, Weight) 69,000 ICD-10-CM DX Codes 70,000 ICD-10-PCS Procedure Codes Legible, Reliable, Precise, Complete, Consistent, Clear & Timely Clinical Documentation 49 SNOMED CT Artificial Intelligence (AI) Computer Assisted Coding (CAC) 49 | ahima.org | © 2020 Medicare- Severity Diagnosis Related Groups (MS-DRGs) • Proper assignment and sequencing of ICD-10-CM and ICD-10- PCS codes generate 1 MS-DRG for each inpatient stay • Major Complications/Comorbidities (MCCs) and Complications/ Comorbidities (CCs) correspond to complex conditions that require increased utilization of resources and, subsequently, a higher relative weight of the MS-DRGs • Higher relative weight MS-DRGs correspond to increased length of stay, higher severity of illness scores, increased utilization of resources and increased level of reimbursement • Accurate and complete clinical documentation, along with appropriate coding, will lead to the assignment of a proper MS- DRG for each inpatient stay 50 | ahima.org | © 2020 MS-DRG Relative Weight Hospital Payment Rate Hospital Reimbursement 49 50
- 26. mHealth Israel 12/13/2020 ©AHIMA 2020 26 Calculating Diagnosis Related Groups (DRGs) Viral Pneumonia • ICD-10-CM: J12.9, Viral pneumonia unspecified COVID-19 Pneumonia • ICD-10-CM: U07.1, COVID-19; J12.89, Other viral pneumonia COVID-19 Pneumonia with Mechanical Ventilator • ICD-10-CM: U07.1, COVID-19; J12.89, Other viral pneumonia • ICD-10-PCS: 5A1955Z, Respiratory ventilation >96 hours MS-DRG Relative Weight Total Reimbursement 195, Simple Pneumonia & Pleurisy without CC/MCC 0.665 $2862.02 MS-DRG Relative Weight Total Reimbursement 177, Respiratory Infections & Inflammations with MCC 1.8453 $9230.20 MS-DRG Relative Weight Total Reimbursement 207, Respiratory System Diagnosis with Ventilator 5.7264 $28,487.37 Learn More! 51 52
- 27. mHealth Israel 12/13/2020 ©AHIMA 2020 27 International Products viaahima.org 53 | ahima.org | © 2020 Melanie Endicott Education/Certification/Customized Trainings • Medical Coding • Clinical Documentation Integrity (CDI) • Revenue Cycle Management (RCM) • Health Privacy and Security • Health Data Analytics and Informatics • Training of Trainers in Coding, CDI, RCM, and more • Telemedicine Advisory • Data Analytics • Analysis of HIM Department and Workflow Processes Memberships, Webinars, Events, and More! https://viaahima.org/ Certifications 54 | ahima.org | © 2020 Melanie Endicott AHIMA Coding Credentials Certified Coding Associate • 6 months training/experience; Entry-level coding Certified Coding Specialist • 2 years experience; Mastery-level hospital coding Certified Coding Specialist-Physician Based • 2 years experience; Mastery-level physician office coding https://viaahima.org/ 53 54
- 28. mHealth Israel 12/13/2020 ©AHIMA 2020 28 Certifications 55 | ahima.org | © 2020 Melanie Endicott AHIMA Specialty Credentials Certified Documentation Improvement Practitioner • 2-year degree + 2 years CDI experience Certified Health Data Analyst • 4-year degree + 3 years healthcare data experience https://viaahima.org/ Designations 56 | ahima.org | © 2020 Melanie Endicott AHIMA International Designations AHIMA International CDI Specialist • Successful completion of AHIMA International CDI training course AHIMA International Privacy and Security Specialist • Successful completion of AHIMA International Privacy & Security training course https://viaahima.org/ 55 56
- 29. mHealth Israel 12/13/2020 ©AHIMA 2020 29 Workshops Available January 2021 57 | ahima.org | © 2020 Melanie Endicott Medical Coding Bootcamp Excellent Reference Book 58 | ahima.org | © 2020 Melanie Endicott Healthcare Code Sets, Clinical Terminologies, and Classification Systems, Fourth Edition by Kathy Giannangelo, MA, RHIA, CCS, CPHIMS, FAHIMA https://my.ahima.org/store/product?id=65948 57 58
- 30. mHealth Israel 12/13/2020 ©AHIMA 2020 30 Thank you! Melanie.Endicott@ahima.org Melanie Endicott, MBA/HCM, RHIA, CDIP, CHDA, CPHI, CCS, CCS-P, FAHIMA American Health Information Management Association Senior Director, International Education and Training https://www.linkedin.com/in/melanieendicott/ 59