The document provides an overview of medical coding, its historical development, and its significance in healthcare, detailing the types of codes used such as CPT and ICD-10-CM. It discusses the importance of accurate coding for reimbursement, research, and patient care, along with guidelines and challenges faced in the coding process. Additionally, it outlines various career opportunities in medical coding and includes interview questions related to the field.

1. MEDICAL CODING
POOJA TIWARI (M PHARMACOLOGY)
• CPC CERTIFIED MEDICAL CODER (2017)
• 5+ YEARS OF INDUSTRIAL EXPERIENCE AS A QUALITY ANALYST
.2YRS EXPERIENCE AS A LECTURER
Speaker :

2. DEFINITION OF MEDICAL CODING
• Medical coding is the process of assigning standardized codes
to medical procedures, diagnoses, and services. These codes
are used for various purposes, including billing,
reimbursement, research, and quality assessment. Medical
coding translates complex medical terms and procedures into a
standardized format that can be easily understood and
interpreted by healthcare professionals, insurance companies,
and other stakeholders in the healthcare industry.

3. HISTORY OF MEDICAL CODING
• The history of medical coding can be traced back to the early 20th
century, when the use of standardised classification systems for
diseases and medical procedures began to gain popularity. In 1900, the
Bertillon Classification of Causes of Death was introduced, which was
used to classify and track mortality statistics.
. In 1910, the International Classification of Diseases (ICD) was
introduced by the World Health Organization (WHO) as a standardised
system for coding diagnoses and diseases.
. In the 1960s, the American Medical Association (AMA) introduced the
Current Procedural Terminology (CPT) coding system, which was
designed to standardise the coding of medical procedures and services
provided by physicians and other healthcare providers.

4. MEDICAL CODING AND ITS IMPORTANCE IN
HEALTHCARE.
• Medical coding is a critical process in healthcare that involves the
transformation of complex medical procedures and diagnoses into
a standardized code format. These codes are used for many
purposes, including billing, reimbursement, research, and quality
assessment.
• Medical coding is essential for the effective functioning of
healthcare systems and the delivery of quality patient care

5. TYPES OF MEDICAL CODES
• There are two main types of medical codes: Current Procedural
Terminology (CPT) codes and International Classification of Diseases,
Tenth Revision, Clinical Modification (ICD-10-CM) codes.
• CPT codes are used to describe medical procedures and services. These
codes are created and maintained by the American Medical Association
(AMA) and are updated annually to reflect changes in medical practice.
• ICD-10-CM codes are used to describe medical diagnoses and
conditions. These codes are maintained by the World Health Organization
(WHO) and are used by healthcare providers and insurance companies
worldwide.
• Together, these two types of codes provide a comprehensive system for
describing and communicating medical procedures, diagnoses, and
services in a standardized format.

6. CPT-CURRENT PROCEDURAL
TERMINOLOGY
• CPT codes consist of five digits, and each code represents a specific
medical procedure or service.
• CPT codes are organized into three categories: Category I, Category
II, and Category III codes.
• Category I codes are the most commonly used and describe medical
procedures and services that are widely performed
• Category II codes are used to report performance measures, while
Category III codes are temporary codes used to describe emerging
technologies and procedures that do not yet have a Category I code.

7. HERE ARE SOME EXAMPLES OF CPT CODES
AND HOW THEY ARE USED.
• 99213 – This code is used to describe a mid-level office visit with an
established patient. This might include a brief examination, review of
medical history, and a prescription refill.
• 45378 – This code is used to describe a colonoscopy procedure. This
might include the insertion of a flexible tube with a camera into the
colon to examine the inside of the colon for abnormalities or disease.
• CPT codes are used to describe a wide variety of medical procedures
and services, and they play a crucial role in the medical billing and
reimbursement process.

8. ICD-10-CM CODES -
• ICD-10-CM codes are a standardized set of codes used to describe medical
diagnoses and conditions. The codes were developed and are maintained by
the World Health Organization (WHO) and are used by healthcare providers
and insurance companies worldwide.
• ICD-10-CM codes consist of alphanumeric characters and are up to seven
digits in length.
• ICD-10-CM codes are organized into chapters based on the body system or
condition being described.
• ICD-10-CM codes are used by healthcare providers to document patient
diagnoses in medical records, and they are used by insurance companies to
determine coverage and reimbursement for medical services.

9. HERE ARE SOME EXAMPLES OF ICD-10-CM
CODES AND HOW THEY ARE USED.
• J45.909 – This code is used to describe uncomplicated asthma. It is
used by healthcare providers to document the patient’s diagnosis in
their medical record, and it is used by insurance companies to
determine coverage and reimbursement for asthma-related medical
services.
• E11.9 – This code is used to describe type 2 diabetes mellitus
without complications. It is used by healthcare providers to document
the patient’s diagnosis in their medical record, and it is used by
insurance companies to determine coverage and reimbursement for
diabetes-related medical services.

10. MEDICAL CODING IS IMPORTANT FOR A
NUMBER OF REASONS.
• The importance of accurate medical coding in healthcare, such
as ensuring proper reimbursement, tracking disease patterns,
and facilitating research.
• Medical coding is essential to the functioning of the healthcare
system. Accurate and consistent coding helps to ensure that
patients receive appropriate care, healthcare providers are
properly reimbursed, and research and public health initiatives
are supported.

11. MEDICAL CODING GUIDELINES.
• Ensuring accurate and consistent coding
• Complying with legal and regulatory requirements
• Maximizing reimbursement
• Maintaining data integrity
• Coding guidelines such as those set by CMS is essential to
ensure accurate and consistent coding, comply with legal and
regulatory requirements, maximize reimbursement, and
maintain data integrity.

12. THE RCM CYCLE OR REVENUE CYCLE
MANAGEMENT
• Encounter – Face to Face encounter with doctor
• Transcription- Converts the audio data in medical record
• Medical coding – Convert the whole medical record into Alfa-
Numeric codes
• Medical billing – Post the payment and charges of the given
code to insurance company
• AR – Denial management and watch on doctor collection.

13. MEDICAL RECORD DOCUMENTATION.
• Documentation provides the basis for coding
• Documentation must be specific
• Documentation must be timely
• Documentation must be consistent

14. TYPES OF MEDICAL RECORD
DOCUMENTATION.
• Progress notes.
• Operative reports
• Diagnostic test results
• Consultation notes
• Medication lists
• Accurate and complete documentation is essential for assigning
accurate diagnosis and procedure codes, which is critical for
reimbursement, research, and patient care.

15. CODING ACCURACY
• Coding accuracy is critical in healthcare because it impacts not only
reimbursement but also patient care and legal compliance.
• Reimbursement
• Legal compliance
• Patient care
• Research
• Reputation
• It is essential for healthcare providers to prioritize coding accuracy and ensure
that they have processes and systems in place to prevent coding errors.

16. CHALLENGES OF MEDICAL CODING
• Medical coding can be challenging due to several factors.
• Changes in coding guidelines
• Complexity of medical procedures
• Specificity of codes
• Electronic health record (EHR) systems
• Billing and reimbursement

17. MEDICAL CODING CAREER
• Medical coding offers a variety of career opportunities, each with its
own unique responsibilities and requirements.
• Medical Coder
• Medical Biller
• Coding Auditor
• Coding Manager
• Medical coding offers a range of career opportunities, each with its
own unique responsibilities and requirements.

18. CONCLUSION
• Medical coding is an essential process in healthcare that involves
translating medical procedures and diagnoses into standardized
codes.
• There are two primary types of medical codes: CPT codes, which are
used to describe medical procedures, and ICD-10-CM codes, which
are used to describe diagnoses and conditions.
• Medical coding offers a variety of career opportunities, including
medical coder, medical biller, coding auditor, and coding manager.
• Inaccurate medical coding can have significant consequences,
including incorrect reimbursement and potential legal issues.

19. Question?

20. INTERVIEW QUESTIONS
• 1. What do you know about medical coding, and why did you choose
to pursue a career in this field?
• 2. What coding systems have you studied or worked with during your
training or education?
• 3. How do you ensure accuracy and compliance with coding
guidelines?
• 4. How do you stay up to date with changes in coding regulations
and guidelines?
• 5. Can you provide an example of a coding challenge you have faced
during your training, and how you resolved it?

21. INTERVIEW QUESTIONS
• 6. How do you prioritize your coding workload when faced with
multiple tasks and deadlines?
• 7. Have you had any experience with electronic health records
(EHRs)? If so, which ones?
• 8. How do you ensure patient confidentiality and privacy in your
coding work?
• 9. How do you handle conflicting information or missing
documentation in medical records?
• 10. How do you handle feedback and criticism in your work?

22. HUMAN ANATOMY AND PHYSIOLOGY
QUESTIONS
• What is the function of the gastrointestinal (GI) system?
-The GI system is responsible for the digestion and absorption
of nutrients, as well as the elimination of waste from the body.
What are the main organs of the GI system?
The main organs include the mouth, esophagus, stomach, small
intestine (duodenum, jejunum, ileum), large intestine (colon),
rectum, and anus.

23. • What are the primary functions of the stomach?
• The stomach serves to store food, mix it with gastric juices, initiate
protein digestion with pepsin, and regulate the release of partially
digested food (chyme) into the small intestine.
• What is the role of the small intestine in digestion and absorption?
• The small intestine is where most of the digestion and absorption of
nutrients occurs. Enzymes from the pancreas and bile from the liver
aid in the breakdown of carbohydrates, proteins, and fats, while
nutrients are absorbed through the intestinal lining into the
bloodstream.

24. • What is the function of the large intestine?
• The large intestine primarily absorbs water and electrolytes
from the remaining indigestible food material, forming feces
for elimination.
• What are common disorders of the GI system?
• Common disorders include gastroesophageal reflux disease
(GERD), peptic ulcers, inflammatory bowel disease (Crohn’s
disease and ulcerative colitis), irritable bowel syndrome (IBS),
and colorectal cancer.

25. • What is the cardiovascular system?
• The cardiovascular system, also known as the circulatory
system, is responsible for circulating blood and transporting
nutrients, oxygen, hormones, and waste products throughout
the body.
• What are the main components of the cardiovascular system?
• The main components include the heart, blood vessels
(arteries, veins, and capillaries), and blood.

26. Thank you