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Similar to MO230 Chapter 001 (20) MO230 Chapter 0011. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 1
The Rationale for and History of
Coding
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. 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.
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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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
16
Coding Organizations and
Credentials
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. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
18
Coding Ethics
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. 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. 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. Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
22
QUESTIONS
Editor's Notes 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.