MO230 Chapter 001

Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 1
The Rationale for and History of
Coding

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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.

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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.

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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)

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Background of Coding
 Nomenclature
 Classification
 Types of
 History of

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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.

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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

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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!

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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)

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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

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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

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Coding Organizations and
Credentials
 Where do coders work?
 Hospitals
 Physician offices
 Outpatient surgical centers
 Long-term care facilities
 Insurance companies
 Prisons
 Government agencies

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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

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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

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Credentials
 Certification examinations
 Keeping coding knowledge current
 Continuing education units (CEUs)
 Minimums are required to maintain certification

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Credentials

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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
Coding Ethics

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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
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?

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Confidentiality
 Covered in:
 Patient Bill of Rights
 HIPAA
 Common sense/need-to-know approach

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QUESTIONS

MO230 Chapter 001

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