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MO230 Chapter 001
- 1. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chapter 1 The Rationale for and History of Coding
- 2. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 Lesson 1.1: The Rationale for and History of Coding ο Describe the application of coding. ο Define nomenclature and classification. ο Identify the historical timeline of coding. ο Explain the difference between ICD-9-CM and ICD- 10-CM. ο Delineate coder training needs for transitioning to ICD-10-CM. ο Describe the different coding organizations and credentials.
- 3. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 Lesson 1.1: The Rationale for and History of Coding ο Recognize the importance of the Standards of Ethical Coding. ο Define compliance as it relates to coding. ο Explain confidentiality as it relates to coding.
- 4. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Background of Coding ο What is coding, and what are its applications? ο International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM & ICD-10-PCS) ο Medicare Severity Diagnosis-Related Groups (MS-DRGs)
- 5. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 Background of Coding ο Nomenclature ο Classification ο Types of ο History of
- 6. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 History of Coding ο 1893: Bertillonβs Classification of Causes of Death ο 1898: Adopted by the American Public Health Association ο World Health Organization (WHO) ο International Classification of Causes of Death ο 1977: Clinical Modifications (CMs) for U.S.
- 7. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 History of Coding ο 1993: ICD-10 published by the WHO ο In use in other countries ο Alphanumeric system ο Implementation in the U.S. slated for October 2014
- 8. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 History of Coding ο ICD-9-CM updated twice a year ο Federal Register publication of updates ο See www.cms.gov ο Current coding tools are a must!
- 9. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 History of Coding ο Development & maintenance of guidelines: ο National Center for Health Statistics (NCHS) ο Centers for Medicare and Medicaid Services (CMS) ο American Hospital Association (AHA) ο American Health Information Management Association (AHIMA)
- 10. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Preparation for Transition to ICD-10- CM ο Differences between ICD-10-CM & ICD-9-CM ο Increase in the number of codes and code categories οChange from numeric to alphanumeric οIncrease in digits from 5 to 7 οIncrease from 17 chapters to 21 chapters
- 11. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Preparation for Transition to ICD-10-CM ο Coders must have in-depth knowledge of ο Anatomy and physiology ο Medical terminology ο Operative reports ο ICD-10-PCS definitions
- 12. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Coding Organizations and Credentials ο Where do coders work? ο Hospitals ο Physician offices ο Outpatient surgical centers ο Long-term care facilities ο Insurance companies ο Prisons ο Government agencies
- 13. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Coding Organizations and Credentials ο American Health Information Management Association (AHIMA) Credentials: ο CCA Certified Coding Associate ο CCS Certified Coding Specialist ο CCS-P Certified Coding Specialistβ Physician-Based ο RHIT Registered Health Information Technician ο RHIA Registered Health Information Administrator
- 14. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Coding Organizations and Credentials ο American Academy of Professional Coders (AAPC) Credentials: ο CPC Certified Professional Coder ο CPC-H Certified Professional Coderβ Hospital-Based ο CPC-P Certified Professional Coderβ Payer-Based
- 15. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Coding Organizations and Credentials ο Certification examinations ο Keeping coding knowledge current ο Continuing education units (CEUs) ο Minimums are required to maintain certification
- 16. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Coding Organizations and Credentials
- 17. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Coding Ethics ο AHIMA and AAPC have standards for ethical coding ο Examples: ο Coding professionals should adhere to coding guidelines ο They should only assign and report codes that are supported by physician documentation ο They should maintain and enhance coding skills
- 18. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Coding Ethics
- 19. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Compliance ο Follow the rules! ο Who makes the rules? ο CMS ο State agencies ο Joint Commission ο Increase in compliance programs ο Health Insurance Portability and Accountability Act of 1996 (HIPAA) ο Increase in compliance officers
- 20. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Compliance ο Make sure you and your department are in compliance ο Steps to ensure compliance ο Have a coding compliance plan ο What should be in the plan?
- 21. Copyright Β© 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Confidentiality ο Covered in: ο Patient Bill of Rights ο HIPAA ο Common sense/need-to-know approach
- 22. Copyright Β© 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 β Classification of diagnoses CMS β 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.