The document discusses ICD-9-CM coding which is used to code morbidity data from medical records. It covers topics like the structure of ICD-9 codes, conventions for sequencing codes, using supplementary classifications like V and E codes, and locating codes in the tabular list and index. Key aspects of coding neoplasms, hypertension, procedures, and poisoning are also summarized.
Introduction to Argus Analysis Tab Screen in Pharmacovigilance or Drug Safety of Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Contact:
"Katalyst Healthcares & Life Sciences"
South Plainfield, NJ, USA
info@KatalystHLS.com
Introduction to Argus Event Tab Screen in Pharmacovigilance or Drug Safety of Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Contact:
"Katalyst Healthcares & Life Sciences"
South Plainfield, NJ, USA
info@KatalystHLS.com
The document discusses never events and present on admission/hospital acquired conditions. It defines never events as clearly identifiable, preventable events that indicate issues with a healthcare organization's safety systems. It lists various categories of never events including surgical, product/device, care management, environment, and criminal events. It explains that never events will be reviewed on a case by case basis and charges may be waived. It then discusses present on admission and hospital acquired conditions, noting that CMS no longer provides higher payments for certain conditions if they were not present on admission. It stresses the importance of properly documenting whether conditions were present on admission.
Denials Management Made Easy By Forefront Technologies
Healthcare Software Solutions. Turn your ERAs into actionable charts and reports. Forefront’s ETL process makes it easy to load your files for reporting. It has all the visualizations you need to easily identify problem areas and trends, with click-throughs and drill-downs to get right to the details.
Argus Screen Shots General Tab - Katalyst HLSKatalyst HLS
Introduction to Argus Screen Shots General Tab - Drug Safety & Pharmacovigilance of Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Contact:
"Katalyst Healthcares & Life Sciences"
South Plainfield, NJ, USA
info@KatalystHLS.com
The document discusses several issues that affect the validity of diagnosing major depressive disorder (MDD), including:
1) Comorbidity with other mental illnesses like anxiety disorders can negatively impact outcomes and treatment response for depression.
2) There is debate around whether distinct subtypes of depression are valid or if they are too similar.
3) Diagnoses made by general practitioners without specialist training may be less reliable and valid compared to diagnoses by mental health specialists.
The following information was taken from Chapter 2 of Buck's Step-by-Step Medical Coding, 2019 Edition. The book is cited on the last slide of the presentation. All information is relevant as of 2019. Any updates after November 2019 will not be in this presentation. This presentation was created through Canva.
The document summarizes a presentation on the transition from ICD-9-CM to ICD-10-CM. It discusses the reasons for replacing ICD-9-CM, including that it is outdated and lacks specificity. It also describes some key differences between ICD-9-CM and ICD-10-CM, such as ICD-10-CM codes having up to 7 characters instead of 3-5. Additionally, it provides an overview of the structure and users of the new ICD-10-CM classification system which will be implemented on October 1, 2013.
Introduction to Argus Analysis Tab Screen in Pharmacovigilance or Drug Safety of Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Contact:
"Katalyst Healthcares & Life Sciences"
South Plainfield, NJ, USA
info@KatalystHLS.com
Introduction to Argus Event Tab Screen in Pharmacovigilance or Drug Safety of Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Contact:
"Katalyst Healthcares & Life Sciences"
South Plainfield, NJ, USA
info@KatalystHLS.com
The document discusses never events and present on admission/hospital acquired conditions. It defines never events as clearly identifiable, preventable events that indicate issues with a healthcare organization's safety systems. It lists various categories of never events including surgical, product/device, care management, environment, and criminal events. It explains that never events will be reviewed on a case by case basis and charges may be waived. It then discusses present on admission and hospital acquired conditions, noting that CMS no longer provides higher payments for certain conditions if they were not present on admission. It stresses the importance of properly documenting whether conditions were present on admission.
Denials Management Made Easy By Forefront Technologies
Healthcare Software Solutions. Turn your ERAs into actionable charts and reports. Forefront’s ETL process makes it easy to load your files for reporting. It has all the visualizations you need to easily identify problem areas and trends, with click-throughs and drill-downs to get right to the details.
Argus Screen Shots General Tab - Katalyst HLSKatalyst HLS
Introduction to Argus Screen Shots General Tab - Drug Safety & Pharmacovigilance of Pharmaceuticals, Bio-Pharmaceuticals, Medical Devices, Cosmeceuticals and Foods.
Contact:
"Katalyst Healthcares & Life Sciences"
South Plainfield, NJ, USA
info@KatalystHLS.com
The document discusses several issues that affect the validity of diagnosing major depressive disorder (MDD), including:
1) Comorbidity with other mental illnesses like anxiety disorders can negatively impact outcomes and treatment response for depression.
2) There is debate around whether distinct subtypes of depression are valid or if they are too similar.
3) Diagnoses made by general practitioners without specialist training may be less reliable and valid compared to diagnoses by mental health specialists.
The following information was taken from Chapter 2 of Buck's Step-by-Step Medical Coding, 2019 Edition. The book is cited on the last slide of the presentation. All information is relevant as of 2019. Any updates after November 2019 will not be in this presentation. This presentation was created through Canva.
The document summarizes a presentation on the transition from ICD-9-CM to ICD-10-CM. It discusses the reasons for replacing ICD-9-CM, including that it is outdated and lacks specificity. It also describes some key differences between ICD-9-CM and ICD-10-CM, such as ICD-10-CM codes having up to 7 characters instead of 3-5. Additionally, it provides an overview of the structure and users of the new ICD-10-CM classification system which will be implemented on October 1, 2013.
V codes in ICD-9-CM are used to report circumstances other than a disease or injury that influence a patient's health status or care, such as regular checkups. Under ICD-10-CM, these codes will be replaced by Z codes. A key difference between ICD-9-CM and ICD-10-CM is that supplementary codes like V codes are incorporated directly into the main classification in ICD-10-CM. V codes provide additional context for a patient encounter and should be used alongside diagnosis codes 001-999. V codes are included in documentation but not coded as the primary diagnosis.
The document discusses the skills and knowledge required for medical coding, including:
1) Knowledge of classification systems such as ICD-9 and CPT codes, and how to apply codes based on a patient's diagnosis, symptoms, procedures, and other factors.
2) The ability to communicate with clinical staff to clarify diagnoses, procedures, documentation, and appropriate code selection and sequencing.
3) The ability to thoroughly research coding questions and consult with others to ensure accurate coding.
4) The ability to analyze medical records in detail to identify all relevant diagnoses and procedures for accurate medical coding.
The document discusses the skills and knowledge required for medical coding, including:
1. Knowledge of classification systems such as ICD-9 and CPT codes, and how to apply codes based on specialty areas and guidelines.
2. The ability to communicate with clinical staff regarding coding, documentation, and establishing medical necessity.
3. The ability to research and solve complex coding questions by collaborating with other professionals.
4. The skill to analyze medical records thoroughly to identify accurate diagnoses and procedures for coding based on documentation and an understanding of disease processes.
This document provides an overview and guidelines for using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). It discusses how ICD-9-CM is used for morbidity coding in the United States and provides the framework, conventions and acknowledgements for the classification system. It also contains the table of contents for the ICD-9-CM Tabular List of Procedures.
The document summarizes the history and use of ICD classification codes for medical diagnoses and procedures. It describes the establishment of ICD-9 in 1975 and its replacement by ICD-10 starting in 2013. ICD-9 is organized into 3 volumes, with volumes 1 and 2 covering diagnoses and volume 3 covering procedures. The document provides examples of how to locate codes in ICD-9 and discusses the increased specificity and number of codes provided in ICD-10.
Eye Part Only
The International Classification of Diseases, 9th Revision, Clinical Modification
(ICD- 9- CM) is based on the official version of the World Health Organization's
9th Revision, International Classification of Diseases
The document discusses various medical coding systems used in healthcare including ICD, CPT, and HCPCS codes. It provides an overview of each coding system including their purpose, format, and how they are used. ICD codes are used for diagnoses and provide a universal vocabulary for causes of injury, illness, and death. CPT codes document medical procedures and services. HCPCS codes include additional services and items not covered by CPT codes, such as durable medical equipment and ambulance rides. Proper medical coding is important for tasks such as medical statistics, reimbursement, payments, and quality review.
Understand what ICD-10 is all about, what it looks like, and how it will affect you and your team. Learn how to create a focused and organized strategic ICD-10 plan
Evaluate and enhance clinical documentation to capture greater detail. Set up and establish documentation agreement with code factors. Get an important timeline to follow so you’re prepped and ready.
Revenue cycle management (RCM) tracks patient care from registration to final payment. It involves providers, payers, patients, and billing companies. Medicare and Medicaid are government insurance programs managed by CMS. Health insurance covers regular checkups, vision, dental, and hospitals. Medicare has four parts that cover different services like inpatient care, outpatient care, and prescription drugs. Medical coding translates diagnoses, procedures, and services into codes to facilitate billing and data analysis. The revenue cycle includes steps like entering patient demographics, medical coding, charge entry, payment posting, accounts receivable management, and patient billing.
Medical records contain a patient's health information and medical history. They are classified using coding and indexing systems. Coding systems like ICD and CPT assign standardized codes to diagnoses, procedures, and services. ICD codes are used globally to classify health conditions while CPT is used in the US to describe medical services. Indexing systems organize patient records alphabetically, numerically, or by subject to facilitate efficient retrieval.
Coding involves converting descriptions of medical diagnoses, procedures, and services into numeric or alphanumeric codes to maximize reimbursement. There are two main coding systems: CPT codes cover medical procedures and services across six categories, while ICD codes cover diseases and conditions and establish medical necessity. Accurately selecting the code that most specifically identifies the documented service or condition according to coding rules is essential for the billing process.
Essential tips for handling cardiology coding and billing1alicecarlos1
Essential Tips for Handling Cardiology Coding and Billing
Medical Billers and Coders (MBC) works with cardiology and other specialty medical practices around the country on billing, coding, contracting, and credentialing to help practices increase efficiencies and maximize revenue. Contact MBC today to learn more about how we can be the perfect partner for your cardiology practice.
Click Here: https://www.medicalbillersandcoders.com/blog/essential-tips-for-handling-cardiology-coding-and-billing/
#guidelinesforcardiology #cardiologypractices #cardiologybillingandcoding #MBC #documentationerrors #cardiologymedicalbillingandcoding #claimsdenials
The following information was taken from Chapter 3 of Buck's Step-by-Step Medical Coding, 2019 Edition. The book is cited on the last slide of the presentation. All information is relevant as of 2019. Any updates after November 2019 will not be in this presentation. This presentation was created through Canva.
Argus Patient Screen Tab Training - Katalyst HLSKatalyst HLS
This document provides instructions for entering patient information, medical history, and laboratory data into the ARGUS patient screening system. It describes how to enter initials only for patient name, date of birth using hyphens for missing parts, and age manually if date of birth is partial. Relevant medical history, including conditions, historical drugs, and family history should be included. Laboratory results should be entered in the coded field if abnormal and relevant to events, and normal tests or those not codable go in the free text field. Dates and details like units should be included.
Part of the Presentation summarizing the Coalition4MECFS.org proposal to reclassify chronic fatigue syndrome (CFS) in the ICD-10-CM (U.S.) on Sept 23, 2011 at the IACFS-ME Association Biennial Conference held in Ottawa, Canada.
The following information was taken from Chapter 4 of Buck's Step-by-Step Medical Coding, 2019 Edition. The book is cited on the last slide of the presentation. All information is relevant as of 2019. Any updates after November 2019 will not be in this presentation. This presentation was created through Canva.
The document provides updates to ICD-10-CM coding guidelines for 2023. Some key updates include clarifying that code assignment for complications of care is based on documentation of a relationship between the condition and care/procedure. Chapter-specific updates include guidance on coding HIV infections, sepsis, malignancies, diabetes, dementia, gestational diabetes, and termination of pregnancy. Social determinants of health codes and codes for underimmunization status are also addressed.
This document provides guidance on how to evaluate medical decision making (MDM) and assign a level of decision making based on the 1995 and 1997 E/M Documentation and Coding Guidelines. It explains the table of risk, one of the preliminary tables used to determine MDM level. It discusses how to classify a problem's status, amount and complexity of data reviewed, and level of risk based on presenting problems, diagnostic tests ordered, and management options. The document provides examples and tips for accurately evaluating each component and avoiding common pitfalls when determining the MDM level.
Medicare provides health insurance for Americans aged 65 and older, or younger with disabilities. It has two parts: Part A covers inpatient care while Part B covers outpatient care. Individuals are eligible if they worked for 10 years in Medicare-covered employment and are a US citizen or permanent resident. Premiums and deductibles apply depending on income and prior payments. Supplemental Medigap plans are offered by private insurers to cover costs not paid by Medicare. The Physician Fee Schedule determines payment rates using the Resource-Based Relative Value Scale. Medicare acts as either the primary or secondary payer depending on an individual's other insurance coverage.
V codes in ICD-9-CM are used to report circumstances other than a disease or injury that influence a patient's health status or care, such as regular checkups. Under ICD-10-CM, these codes will be replaced by Z codes. A key difference between ICD-9-CM and ICD-10-CM is that supplementary codes like V codes are incorporated directly into the main classification in ICD-10-CM. V codes provide additional context for a patient encounter and should be used alongside diagnosis codes 001-999. V codes are included in documentation but not coded as the primary diagnosis.
The document discusses the skills and knowledge required for medical coding, including:
1) Knowledge of classification systems such as ICD-9 and CPT codes, and how to apply codes based on a patient's diagnosis, symptoms, procedures, and other factors.
2) The ability to communicate with clinical staff to clarify diagnoses, procedures, documentation, and appropriate code selection and sequencing.
3) The ability to thoroughly research coding questions and consult with others to ensure accurate coding.
4) The ability to analyze medical records in detail to identify all relevant diagnoses and procedures for accurate medical coding.
The document discusses the skills and knowledge required for medical coding, including:
1. Knowledge of classification systems such as ICD-9 and CPT codes, and how to apply codes based on specialty areas and guidelines.
2. The ability to communicate with clinical staff regarding coding, documentation, and establishing medical necessity.
3. The ability to research and solve complex coding questions by collaborating with other professionals.
4. The skill to analyze medical records thoroughly to identify accurate diagnoses and procedures for coding based on documentation and an understanding of disease processes.
This document provides an overview and guidelines for using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). It discusses how ICD-9-CM is used for morbidity coding in the United States and provides the framework, conventions and acknowledgements for the classification system. It also contains the table of contents for the ICD-9-CM Tabular List of Procedures.
The document summarizes the history and use of ICD classification codes for medical diagnoses and procedures. It describes the establishment of ICD-9 in 1975 and its replacement by ICD-10 starting in 2013. ICD-9 is organized into 3 volumes, with volumes 1 and 2 covering diagnoses and volume 3 covering procedures. The document provides examples of how to locate codes in ICD-9 and discusses the increased specificity and number of codes provided in ICD-10.
Eye Part Only
The International Classification of Diseases, 9th Revision, Clinical Modification
(ICD- 9- CM) is based on the official version of the World Health Organization's
9th Revision, International Classification of Diseases
The document discusses various medical coding systems used in healthcare including ICD, CPT, and HCPCS codes. It provides an overview of each coding system including their purpose, format, and how they are used. ICD codes are used for diagnoses and provide a universal vocabulary for causes of injury, illness, and death. CPT codes document medical procedures and services. HCPCS codes include additional services and items not covered by CPT codes, such as durable medical equipment and ambulance rides. Proper medical coding is important for tasks such as medical statistics, reimbursement, payments, and quality review.
Understand what ICD-10 is all about, what it looks like, and how it will affect you and your team. Learn how to create a focused and organized strategic ICD-10 plan
Evaluate and enhance clinical documentation to capture greater detail. Set up and establish documentation agreement with code factors. Get an important timeline to follow so you’re prepped and ready.
Revenue cycle management (RCM) tracks patient care from registration to final payment. It involves providers, payers, patients, and billing companies. Medicare and Medicaid are government insurance programs managed by CMS. Health insurance covers regular checkups, vision, dental, and hospitals. Medicare has four parts that cover different services like inpatient care, outpatient care, and prescription drugs. Medical coding translates diagnoses, procedures, and services into codes to facilitate billing and data analysis. The revenue cycle includes steps like entering patient demographics, medical coding, charge entry, payment posting, accounts receivable management, and patient billing.
Medical records contain a patient's health information and medical history. They are classified using coding and indexing systems. Coding systems like ICD and CPT assign standardized codes to diagnoses, procedures, and services. ICD codes are used globally to classify health conditions while CPT is used in the US to describe medical services. Indexing systems organize patient records alphabetically, numerically, or by subject to facilitate efficient retrieval.
Coding involves converting descriptions of medical diagnoses, procedures, and services into numeric or alphanumeric codes to maximize reimbursement. There are two main coding systems: CPT codes cover medical procedures and services across six categories, while ICD codes cover diseases and conditions and establish medical necessity. Accurately selecting the code that most specifically identifies the documented service or condition according to coding rules is essential for the billing process.
Essential tips for handling cardiology coding and billing1alicecarlos1
Essential Tips for Handling Cardiology Coding and Billing
Medical Billers and Coders (MBC) works with cardiology and other specialty medical practices around the country on billing, coding, contracting, and credentialing to help practices increase efficiencies and maximize revenue. Contact MBC today to learn more about how we can be the perfect partner for your cardiology practice.
Click Here: https://www.medicalbillersandcoders.com/blog/essential-tips-for-handling-cardiology-coding-and-billing/
#guidelinesforcardiology #cardiologypractices #cardiologybillingandcoding #MBC #documentationerrors #cardiologymedicalbillingandcoding #claimsdenials
The following information was taken from Chapter 3 of Buck's Step-by-Step Medical Coding, 2019 Edition. The book is cited on the last slide of the presentation. All information is relevant as of 2019. Any updates after November 2019 will not be in this presentation. This presentation was created through Canva.
Argus Patient Screen Tab Training - Katalyst HLSKatalyst HLS
This document provides instructions for entering patient information, medical history, and laboratory data into the ARGUS patient screening system. It describes how to enter initials only for patient name, date of birth using hyphens for missing parts, and age manually if date of birth is partial. Relevant medical history, including conditions, historical drugs, and family history should be included. Laboratory results should be entered in the coded field if abnormal and relevant to events, and normal tests or those not codable go in the free text field. Dates and details like units should be included.
Part of the Presentation summarizing the Coalition4MECFS.org proposal to reclassify chronic fatigue syndrome (CFS) in the ICD-10-CM (U.S.) on Sept 23, 2011 at the IACFS-ME Association Biennial Conference held in Ottawa, Canada.
The following information was taken from Chapter 4 of Buck's Step-by-Step Medical Coding, 2019 Edition. The book is cited on the last slide of the presentation. All information is relevant as of 2019. Any updates after November 2019 will not be in this presentation. This presentation was created through Canva.
The document provides updates to ICD-10-CM coding guidelines for 2023. Some key updates include clarifying that code assignment for complications of care is based on documentation of a relationship between the condition and care/procedure. Chapter-specific updates include guidance on coding HIV infections, sepsis, malignancies, diabetes, dementia, gestational diabetes, and termination of pregnancy. Social determinants of health codes and codes for underimmunization status are also addressed.
This document provides guidance on how to evaluate medical decision making (MDM) and assign a level of decision making based on the 1995 and 1997 E/M Documentation and Coding Guidelines. It explains the table of risk, one of the preliminary tables used to determine MDM level. It discusses how to classify a problem's status, amount and complexity of data reviewed, and level of risk based on presenting problems, diagnostic tests ordered, and management options. The document provides examples and tips for accurately evaluating each component and avoiding common pitfalls when determining the MDM level.
Medicare provides health insurance for Americans aged 65 and older, or younger with disabilities. It has two parts: Part A covers inpatient care while Part B covers outpatient care. Individuals are eligible if they worked for 10 years in Medicare-covered employment and are a US citizen or permanent resident. Premiums and deductibles apply depending on income and prior payments. Supplemental Medigap plans are offered by private insurers to cover costs not paid by Medicare. The Physician Fee Schedule determines payment rates using the Resource-Based Relative Value Scale. Medicare acts as either the primary or secondary payer depending on an individual's other insurance coverage.
This document summarizes key issues around the allocation of scarce medical resources. It notes the large disparity between the number of people on organ transplant waiting lists compared to the number of actual transplants performed. It also discusses ethical dilemmas around issues like selling kidneys in India and guidelines for determining morally right actions. The document outlines five philosophical principles of medical ethics: non-malfeasance, beneficence, autonomy, fidelity, and justice.
Physicians have certain public duties that they must perform according to law, including filling out birth and death certificates, reporting communicable diseases and injuries, documenting evidence of abuse, and addressing issues related to substance abuse and vaccinations. They must also properly collect and preserve evidence. Good Samaritan laws provide liability protection for physicians who provide emergency care outside of their normal duties. Failure to fulfill these public duties can result in civil or criminal penalties for physicians.
CPT codes are organized into six main sections: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine. The CPT manual indexes procedures alphabetically by procedure name, body organ, and condition. Symbols provide additional information about codes, such as modifiers that specify alterations to services. Evaluation and Management codes consider the extent of history taken and exam performed, medical decision complexity, counseling, care coordination and other factors to determine the level of service provided to the patient.
A Native American healer performed a purification ritual on an afflicted person before an ambulance crew arrived to treat them, highlighting cultural differences in healing practices. The document discusses that culture defines identities and influences beliefs about illness, acceptable behaviors, and health maintenance. It provides tips for healthcare practitioners, such as understanding a patient's cultural norms to better interpret their reactions and considering how culture may impact willingness to discuss symptoms.
The document discusses consent in medical care, including the definitions of informed consent and the doctrine of informed consent. It explains that informed consent requires the patient understands and voluntarily agrees to examination or treatment after being informed of what the procedure entails, possible risks and alternatives. The vignette shows how a physician can be found liable if a patient refuses a recommended test but is not adequately informed of the risks of not undergoing it. Problems obtaining consent from minors, issues of language or competency are also addressed.
This document discusses several key legal and regulatory issues related to healthcare privacy, security, and billing standards. It covers federal laws like HIPAA, Medicare, and the False Claims Act. HIPAA established standards for electronic health transactions, privacy of health information, and security of health data. The document also discusses forms of Medicare fraud like unbundling codes, overpayments, provider liability, and the National Correct Coding Initiative to prevent unbundling. It provides an overview of administrative simplification efforts and unique identifiers required under HIPAA.
This document discusses the life cycle of an insurance claim, including:
1) Processing the CMS-1500 claim form by transferring information from medical records. Providers can accept assignment to be reimbursed directly by the insurance company.
2) Managing patients by verifying insurance information, generating encounter forms, and collecting copayments. Primary and secondary insurance is determined.
3) Submitting claims electronically or manually. Claims are processed, adjudicated by comparing to benefits and edits, and then paid or denied with an explanation of benefits sent.
Civil law governs relations between individuals and organizations, and is used when a wrongful act is committed against another person. Criminal law governs relations between individuals and the government, and is used when a wrongful act harms society. The Controlled Substances Act classifies drugs into five schedules based on their potential for abuse and addiction, from Schedule I which has no accepted medical use to Schedule V which has a limited addiction potential. Prescriptions must be issued and signed only by the registered health professional. A subpoena is a court order that can demand a person or medical records, while an expert witness testifies in court about the standard of care in a particular medical field.
This document provides an overview of key concepts in health insurance and managed care. It defines health insurance and managed care, discusses primary care providers and their gatekeeping role. It also outlines different managed care models like HMOs, PPOs, and consumer-directed health plans. Quality assurance and utilization management processes are described as ways to control costs and ensure quality of care. Medical documentation standards and the use of electronic health records are also summarized.
This document summarizes chapters 2 and 3 from a medical practice management textbook. It discusses different types of medical practice structures like sole proprietorships and partnerships. It also defines key terms related to medical staff credentials and licensure requirements. The document also provides vignettes about a medical office manager reflecting on the growth of their clinic over 30 years and an unprofessional comment made by a consultant's receptionist about a referring physician.
Health insurance specialists review medical claims submitted by providers to determine if the services and procedures meet medical necessity requirements for reimbursement. They must have a strong understanding of medical coding systems like ICD-9 and CPT codes. The role requires analyzing documentation, applying coding guidelines, communicating with providers and insurance companies, and ensuring accurate billing and payment. Ongoing training is needed to stay up to date with changing rules and regulations.
C:\Fakepath\Chapter 1 & ProfessionalismSandy Thunell
This document discusses key concepts in medical ethics including laws, ethics, bioethics, and philosophical principles that guide the field. It also addresses codes of ethics from professional organizations and expectations of professionalism for medical assistants. Some topics that can present ethical issues are access to care, informed consent, confidentiality, advance directives, abortion, and physician-assisted suicide. Professionalism in the workplace involves exhibiting courteous, conscientious, and business-like behavior as well as maintaining confidentiality, loyalty, dependability, and compassion for patients.
The document provides an overview of the male reproductive system including terminology, anatomy and physiology, sexually transmitted diseases, and prostate health. It defines key terms related to the male genitalia and reproductive processes. The anatomy section describes the structures of the scrotum, testes, epididymis, vas deferens, seminal vesicles, ejaculatory duct, glands and penis. Sexually transmitted diseases discussed include HIV/AIDS, chlamydia, herpes, HPV, gonorrhea, syphilis, and trichomoniasis. Finally, prostate health conditions like prostatitis, BPH, cancer, and treatments such as PSA testing and TURP are outlined.
This document provides an overview of urology terminology and concepts. It defines medical prefixes and suffixes commonly used in urology. Key aspects of kidney function like the nephron and renal circulation are described. Common urological diseases, conditions, procedures and lab tests are also outlined including end stage renal disease, urinary tract infections, kidney stones, lithotripsy and cystoscopy.
This document provides an overview of neurology terminology basics related to parts of the nervous system, neurotransmitters, and common neurology diseases and conditions. It includes prefixes and suffixes used in neurology terminology, lists the main neurotransmitters, and covers illnesses such as cerebral vascular accident, concussion, dementia, epilepsy, meningitis, and multiple sclerosis.
This document provides an overview of the muscular system, including the three types of muscles, basic terminology related to muscles, major muscles of the body, and common diseases and conditions that affect muscles. Key terms are defined, such as atrophy, contracture, muscle spasm, strain, and various suffixes used in muscular-related terminology. Common reflex tests are also briefly mentioned.
This document contains information about an orthopedics class, including announcements about midterms and final exams. It also includes terminology related to bones and skeletal structures, medical conditions like arthritis, and a medical terminology bee competition. Key terms are defined in prefixes like osteo/osseo, skeleto, and suffixes like algia/dynia and malacia that indicate bones, skeleton, and pain or softening respectively.
This document provides terminology and definitions for various dermatological terms and procedures. It includes:
1) Definitions of prefixes and suffixes commonly used in dermatological terminology referring to skin, hair, nails, pigmentation, and other structures.
2) A description of botulinum toxin injections which are used to relax muscles and are injected into specific muscles, lasting 4-6 months with potential temporary bruising.
3) An overview of collagen injections which are used to replenish skin's natural collagen by injecting bioengineered human collagen into the dermis.
Although the guidelines were originally developed for use in submitting government claims, insurance companies have also adopted them. TIP: Most critical rule involves beginning the search for the correct code assignment using the Index to Diseases/of Diseases.
ICD-9-CM is organized into three volumes: Volume 1: Tabular List Volume 2: Index to Diseases Volume 3: Index to Procedures and Tabular List Medical necessity Tabular List and Index to Diseases Used in provider and health facilities to code diagnoses Index to Procedures and Tabular List Used in hospitals to code inpatient procedures Publishers make coding easier by placing the Index to Diseases in front of the Tabular List Volume 2 Index to Diseases – alphabetical listings of main terms or conditions Volume 3 Included in hospital version of commercial ICD-9-CM books Medical necessity: Determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury Criteria; Purpose; Scope; Evidence; Value
Results Improved ability to measure health care services Increased sensitivity when refining grouping and reimbursement methodologies Enhanced ability to conduct public health surveillance Decreased need to include supporting documentation with claims Includes updated medical terminology and classification of diseases, provides codes to allow comparison of mortality and morbidity data, and provides better data for Measuring care furnished to patients Designing payment systems Processing claims Making clinical decisions Tracking public health Identifying fraud and abuse Conducting research
In the outpatient setting, the first-listed diagnosis is used Documentation should describe patient’s condition using terminology that includes specific diagnoses as well as symptoms, problems, or reasons for the encounter. Term first-listed diagnosis is used Determined in accordance with ICD-9-CM’s coding conventions as well as general and disease-specific coding guidelines Outpatient treated in one of four settings Ambulatory Surgery Center (ASC) Patient is released prior to a 24-hour stay Health care provider’s office 3. Hospital clinic, emergency or outpatient department, or same-day surgery unit 4. Hospital observation setting Patient’s length of stay is 23 hours, 59 minutes, and 59 seconds or less TIPs: Outpatient surgery Code reason for surgery as the first-listed diagnosis (reason for the encounter) Even if surgery is not performed due to a contraindication Observation stay When a patient is admitted for observation for a medical condition, assign a code for the medical condition as the first-listed diagnosis. Outpatient surgery requires observation stay: A patient presents for outpatient surgery and develops complications requiring admission to observation. Code the reason for the surgery as the first reported diagnosis, followed by codes for the complications as secondary diagnoses. An inpatient is a person admitted to a hospital or long-term care facility for treatment with an expected stay of 24 hours or more Inpatient principal diagnosis Condition determined after study that resulted in the patient’s admission to the hospital UB-04 secondary diagnoses include comorbidities and complications
Codes with three digits: Included in ICD-9-CM as the heading of a category of disease codes Maybe further subdivided into four or five digits Provide greater specificity Three-digit disease code is assigned only if it is not further subdivided. If fourth-digit subcategories or fifth-digit sub-classifications are provided They must be assigned If not the code is invalid
Do not code diagnoses documented as Probable, suspected, questionable, rule out, or working diagnosis, because these are considered qualified diagnoses Instead code condition to highest degree of certainty for that encounter Necessary part of patient chart and are reported on UB-04 for inpatient hospital claims Qualified diagnosis Working diagnosis that is not yet proven or established Example: Suspected pneumonia Code the sign or symptom: Wheezing, shortness of breath, etc. Code all that coexist at the time of the encounter, and require or affect patient care, treatment, or management. Do not code conditions that were previously treated and no longer exist. However, history codes may be reported as secondary codes
Assign a code to the diagnosis for which the surgery was performed. If the postoperative diagnosis is different from the preoperative diagnosis when the diagnosis is confirmed, assign a code to the postoperative diagnosis instead
For routine outpatient prenatal visits when no complications are present, report code V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy) as the first-listed diagnosis.
Morphology of Neoplasms (M codes) contains a reference to the World Health Organization publication entitled International Classification of Diseases for Oncology Morphology Indicates tissue type of a neoplasm Benign Not cancerous Malignant Cancerous Within the ICD-9CM Index to Diseases Two official tables that make it easier to code hypertension and neoplasms
Main terms Printed in boldface type and are followed by the code number Subterms (essential modifiers) Qualify the main term by listing alternate sites, etiology, or clinical status
Codes in slanted brackets always coded as secondary Diabetic (cateract) Eponyms named for person Barlow’s Syndrome Essential modifiers are subterms indented below main term NEC not elsewhere classified cant find a more specific code Nonessential modifiers subterms in parenthesis Notes in boxes to define terms See go to more specific term suggested See also may provide additional information See also condition See Table 6-3 page 161 for coding conventions for Tabular List
Chapters Chapter heading printed in uppercase letters and preceded by the chapter number Instructional “Notes” that follow the chapter heading detail general guidelines for code selections within the entire chapter EXCLUDES statement , reference applies to entire chapter Major Topic Headings Printed in bold uppercase letters and followed by codes in parentheses Categories Major topics are divided into three-digit categories: Printed in upper and lower case and are followed by three-digit codes Subcategories Four-digit subcategories are indented and printed in the same way as major category headings. Subclassifications Some fourth digits are more subdivided into subclassifications, which require the task of a fifth digit. Fifth digits Required when indicated in the code book Fifth-digit entries are associated with Chapters Major topic headings Categories Subcategories Make sure that the code number is appropriate for age and gender of patient. Return to Index to Disease for other possible code selections. If code description does not fit condition or reason for visit Enter final code.
Neoplasms New growths or tumors, where cell reproduction is out of control Provider should specify whether the tumor is benign or malignant Should be coded from pathology report Another term related with neoplasm is lesion Defined as any discontinuity of tissue Primary Malignancy Original tumor site All malignant tumors are considered primary: Unless otherwise documented as metastatic or secondary Secondary Malignancy Tumor has spread to a secondary site. Either adjacent to the primary site or to a distant area of the body Carcinoma (Ca) in situ Tumor that is localized, limited, encapsulated, and noninvasive Benign Noninvasive, nonspreading, nonmalignant tumor Uncertain behavior Pathology impossible to predict subsequent morphology or behavior from the submitted specimen Unspecified nature Neoplasm is identified But no more signs of histology or nature of the tumor is in the documented diagnosis Primary Malignancies Malignancy is coded as the primary site if the diagnostic statement documents Metastatic from a site Spread from a site Primary neoplasm of a site Malignancy for which no specific classification is documented Recurrent (repeating) tumor Secondary Malignancies Metastatic and show that a primary cancer has spread to another Cancer described as metastatic from a site is primary of that site: Assign code to the primary neoplasm. Assign second code to the secondary neoplasm of the specified site or unspecified site.
Poisoning Assigned according to classification of drug or chemical Accident Accidental overdosing Wrong substance given Drug inadvertently taken Accidents during a medical surgical procedure Therapeutic use Effect caused by proper substance administered in therapeutic setting Suicide attempt Self-inflicted poisoning Assault Poisoning inflicted by another person who intended to kill or injure the patient Undetermined If used, it will not state whether poisoning was intentional or accidental E codes are used to explain cause of poisoning or effect .
Classification of factors influencing the person’s health status These services fall into one of three categories: Problems Issues that could affect patient’s health status Services Patient seen for treatment not caused by illness or injury Factual reporting Used for statistical purposes Persons with potential health hazards related to communicable diseases Persons with need for isolation, other health hazards, and prophylactic measures Person with potential health related to personal or family history Persons encountering services in circumstances related to reproduction and development Live born infants according to type of birth Person with a condition influencing their health Encountering health services for specific procedures and aftercare Encountering health services in other circumstances Person without reported diagnosis encountered during examination and investigation of individuals and population