Comprehensive Medical Coding and Billing Training for the AAPC CPC Exam. Online Training with videos and Skype sessions. HIPAA Training included along with Medical Billing. Trainer is Dr Guptha, world record holder.

1. Medical Coding-2017Medical Coding-2017
Dr. Santosh Kumar Guptha Trainer/Author
CCS-P, CCS , CPC, COC, CIC, CPC-P, CRC, CCC, CPCO, CANPC,
CPB,CPMA, CEMC, CEDC, CIMC, CFPC, CUC, COBGC, CPCD,
COSC, CPRC, CPEDC, CHONC, CENTC, CRHC, CGIC, CASCC,
CGSC, CSFAC, CCVTC, RMC, RMA, CMBS, CMRS, CSCS, CSBB,
FCR, FNR, FOR, CHA, CHL7,
AHIMA Approved ICD-10 Trainer,
AHIMA ICD-10 Ambassador, India.
World Record Holder-42
Certifications

2.  The medical industry is experiencing a high demand for
individuals with knowledge of medical office operations,
transcription, billing and coding. The business office of
every health care provider must submit the proper
documentation to a number of insurance companies for
reimbursement in order to financially succeed and avoid
fraud charges
 The requirement has created numerous opportunities
for trained individuals to be employed in medical
offices, clinics, hospitals, insurance companies and do
home-based opportunities

3. Medical coding means coverting medical
record to codes. Assigning proper codes for
Diagnosis, Procedure and supplies/drugs
ICD-10-CM is for Diagnosis
ICD-10-PCS is for Hospital Services
CPT-4 is for Physician Services
HCPCS is for Supplies and Drugs

4.  ICD-10 represents the “WHY” it was done
Medical Necessity--------- R07.9
(Chest Pain)
 CPT-4 represents the “WHAT” was done to the patient-
Physician Service
Procedure------------------- 93010 (EKG)
 ICD-10-PCS Represents Hospital Service
0DTJ4ZZ Resection of Appendix, Percutaneous
Endoscopic Approach
HCPCS-is for Supplies and Drugs-Not used in India

5. Key medical terms are identified &
abstracted from the medical record.
Specific codes are assigned to each term.
Resources You Need
ICD-10-CM Manual-2017
ICD-10-PCS Manual-2017
CPT 2017
HCPCS 2017

6. AKA’s of the Medical CoderAKA’s of the Medical Coder
Health Information Technician
Health Information Coder
Medical Record Coder
Coder / Abstractor
Coding Specialist
Insurance Specialist

7. Qualities of the Medical CoderQualities of the Medical Coder
Knowledge of medical terminology
Knowledge of anatomy & physiology
Detail oriented
Accuracy
Critical thinking
Willingness to learn
Self-motivated • Flexibility • Computer
skills

8. Principle of Medical CodingPrinciple of Medical Coding
If it’s not documented, it
wasn’t done

9. ICD-10-CM-2017ICD-10-CM-2017
The International Classification of Diseases (ICD) is
the international standard diagnostic classification
for all general epidemiological purposes, many health
management purposes, and for clinical use.
ICD-10, Clinical Modification (ICD-10-CM) was
developed by the U.S. National Center for Health
Statistics (NCHS) along with an advisory panel to
ensure accuracy and utility in 1993.

10. The WHO is currently crafting the 11th revision,
which is expected to be release in 2018/2019.
ICD-10, Clinical Modification (ICD-10-CM) was
developed by the U.S. National Center for Health
Statistics (NCHS) along with an advisory panel to
ensure accuracy and utility in 1993.
ICD-10 codes allow for greater specificity and
exactness in describing a patient’s diagnosis
and in classifying inpatient procedures.

11. Benefits to ICD-10-CMBenefits to ICD-10-CM
include but are not limited to the following:
•Improving payment systems and reimbursement
accuracy
•Measuring the quality, safety and efficacy of care
•Improve disease management
•Conducting research, epidemiogical studies, and
clinical trials
•Setting health policy
•Monitoring resource utilization
•Preventing and detecting healthcare fraud and
abuse

12. Clinical documentation is a vital component that
represents the medical condition of the patient and,
therefore, has always played a vital role in medical
coding. billing, medical research, hospital/physician
outcome studies, etc.
Complete, accuracy, specific and timely
Proper documentation is required

13. Medical Record Documentation:-Medical Record Documentation:-
1. The medical record should be complete and legible.
2. The documentation of each patient encounter should
include: the date; the reason for the encounter;
appropriate history and physical exam in relationship
to the patient’s chief complaint; review of lab, x-ray
data, and other ancillary services, where appropriate;
assessment; and a plan for care (including discharge
plan, if appropriate)
3. Past and present diagnoses should be accessible to
the treating and/or consulting physician.
4. The reasons for—and results of—x-rays, lab tests, and
other ancillary services should be documented or
included in the medical record.

14.  Relevant health risk factors should be identified.
 The patient’s progress, including response to treatment,
change in treatment, change in diagnosis, and patient
noncompliance, should be documented.
 The written plan for care should include, when appropriate:
treatments and medications, specifying frequency and dosage;
any referrals and consultations; patient/family education; and
specific instructions for follow-up.
 The documentation should support the intensity of the patient
evaluation and/or treatment, including thorough processes
and the complexity of medical decision-making as it relates to
the patient’s chief complaint for the encounter.
 All entries to the medical record should be dated and
authenticated.

15. ICD-10-CM codes are all alphanumeric, starting with
an alpha character

16. A medical record should be kept clear and legible
For the documentation of each patient encounter, the following
information should be included: reason for the encounter, date,
laboratory and tests data, physical examinations, medical history,
assessments, and plan of care.
The medical professional should make sure that previous and current
diagnoses are always accessible to whomever will handle the case.
Ancillary services should be clear, including the results and/or any
intervention initiated.
All of the following should also be documented regarding patient
response: reactions to treatments, changes on the procedures,
noncompliance on the part of the patient, and any changes on the
diagnosis.

17.  A & B = Certain Infectious and Parasitic Diseases
 C & D = Neoplasms
 D = Diseases of the Blood and Blood-forming Organs
 E = Endocrine Nutritional and Metabolic Diseases
 F = Mental, Behavioral, Neurodevelopmental Disorders
 G = Diseases of the Nervous System
 H = Diseases of the Eye and Adnexa
 H = Diseases of the Ear and Mastoid Process
 I = Diseases of the Circulatory System
 J = Diseases of the Respiratory System
 K= Diseases of the Digestive System
 L = Diseases of the Skin and Subcutaneous Tissue
 M = Diseases of the Musculoskeletal System
ICD-10-CM ChaptersICD-10-CM Chapters

18.  N = Diseases of the Genitourinary System
 O = Pregnancy, Childbirth and the Puerperium
 P = Certain Conditions Originating in the Perinatal Period
 Q = Congenital Malformations, Deformations and Chromosomal
Abnormalities
 R = Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not
Elsewhere Classified
 S & T = Injury, Poisoning and Certain Other Consequences of External
Causes
 V = Transport accidents - External Causes of Morbidity
 W = Other External Causes of Accidental Injury
 X = Exposure to smoke, fire and flames
 X - Y = Assault
 Z = Factors Influencing Health Status and Contact With Health Services
 Medical coding training hyderabad

19. XX XX XX XX
Category
.
Etiology, anatomic
site, severity
Added 7th
character for
obstetrics, injuries, and
external causes of injury
ICD-10-CM Coding CharactersICD-10-CM Coding Characters
XX XX XXAAMMSS 00 22 66. 55 xx AA
Additional
Characters
Alpha
(Except U)
2 Numeric
3-7 Numeric or Alpha
3–7 Characters

20. 55thth
Character “x”Character “x”
 Character “x” is used as a 5th character
placeholder in certain 6 character codes to allow
for future expansion and to fill in other empty
characters (e.g., character 5 and/or 6) when a
code that is less than 6 characters in length
requires a 7th character
Examples:
 T46.1x5A – Adverse effect of calcium-channel
blockers, initial encounter; and
 T15.02xD – Foreign body in cornea, left eye,
subsequent encounter.

21. XX XX XX XX
Category
.
Etiology, anatomic
site, severity
Added 7th
character for
obstetrics, injuries, and
external causes of injury
Coding and Seventh CharacterCoding and Seventh Character
XX XX XXAAMMSS 00 22 66. 55 xx AA
Additional
Characters
Alpha
(Except U)
2 Numeric
3-7 Numeric or Alpha
3–7 Characters

22. CODING AND USE OF SEVENTH CHARACTERCODING AND USE OF SEVENTH CHARACTER
•Used in these
chapters:
• Obstetrics
• Injury
• External
cause
• Musculoskelet
al
•Either alpha or
numeric
•Placeholder X
•Meanings vary

23. Surgeon performs an open
cholecystectomy for acute cholecystitis
with cholelithiasis.
K80.00 Calculus of gallbladder with
acute cholecystitis, without
obstruction
0FT40ZZ Open resection of
gallbladder

25. Introduction to CPT CodingIntroduction to CPT Coding
 CPT-4 represents the “WHAT” was done to the patient
Procedure------------------- 93010 (EKG)-5 Digit
Code
Text organized in 6 major sections
 Evaluation and Management (99201 - 99499)
 Anesthesiology (00100 - 01999,
99100 - 99140)
 Surgery (10040 - 69990)
 Radiology (70010 - 79999)
 Pathology and Laboratory (80049 - 89399)
 Medicine (90281 - 99199)

26. CPT CodesCPT Codes
 Developed as a stand-alone descriptions of the
procedures
 To conserve space, some are not printed in their
entirety but refer back to a common portion
listed in a preceding entry**
Example:
25100-arthrotomy, wrist joint; for biopsy
25105 for synovectomy

27. Seven Character Alphanumeric Code
◦ AllAll procedure codes will be seven characters long
◦ “II” and “OO” (letters) are never used
34 possible values for each character
◦ Digits 0 – 9
◦ Letters A-H, J-N, P-Z
27
ICD-10-PCS: Code StructureICD-10-PCS: Code Structure

28. A charactercharacter is a stable, standardized code
component
◦ Holds a fixed place in the code
◦ Retains its meaning across a range of codes
A valuevalue is an individual unit defined for
each character
28
ICD-10-PCS StructureICD-10-PCS Structure
(Characters and Values)(Characters and Values)

29. 1st
character = SSection
2nd
character = BBody System
3rd
character = RRoot Operation
4th
character = BBody Part
5th
character = AApproach
6th
character = DDevice
7th
character = QQualifier
SSusieusie BBuysuys RRootoot BBeereer AAtt DDairyairy
QQueenueen
29

30. ICD-10-PCS Code FormatICD-10-PCS Code Format
S 3 2 0 1 0 A
Section
Body
System
Root
Operation
Body
Part
Approac
h
Device
Qualifie
r

31.  ICD-10 Procedure Code
 0DN90ZZ Release of duodenum, open approach
 0FB03ZX Excision of liver, percutaneous approach,
diagnostic
 02PS0CZ Removal, extraluminal device from
pulmonary vein, right, open

32. Board Exams-USA (AAPC andBoard Exams-USA (AAPC and
AHIMA)AHIMA)
 AAPC: American Academy of Professional Coders-USA
Exam-CPC: Certified Professional Coder
Fees: 500 USD, 2 attempts
Exam Center- Delhi, Mumbai, Chennai, Bangalore, Hyderabad
Required minimum 200 hours of training to clear the exam.
Should learn Coding conventions, HIPAA complaince,
Medical Billing
Medesun Healthcare Solutions-

33. Board Exam-USABoard Exam-USA
AHIMA: American Health Information
Management Association
Exam-CCS: Certified Coding Specialist
Fees: 299 USD, 1 attempt
Exam Center- Delhi, Mumbai, Chennai, Bangalore, Hyderabad
Required minimum 250 hours of training to clear the exam.
Should learn Coding conventions, HIPAA compliance,
Hospital Coding and Medical Billing
Medesun Healthcare Solutions-AHIMA Ambassador India.

34. FreeDigitalPhotos.net

35. Thank you!Thank you!
Contact Information:
MEDESUN HEALTHCARE SOLUTIONS
PLOT 6, ROAD 1, DOCTORS COLONY
SAROORNAGAR-HYDERABAD
Phone-9966933693, 040-65266444
Email: info@medesun.com
http://www.medesunglobal.com