MEDICAL CODING STANDARD

Medical Coding makes the claims process that much easier and reliable. Whenever a patient undergoes professional health care be it in a physician’s clinic, hospital OP facility or a surgical centre, the provider must document the service provided. The medical coder assigns codes to both report the procedures and to provide the medical biller with the information necessary to process a claim for reimbursement by the relevant insurance agency. Firstly, coders must have a thorough knowledge of anatomy and medical terminology. They should be familiar with different types of insurance plans, regulations, compliance, and the coding books: CPT®, HCPCS Level II and ICD-9-CM along with their corresponding codes and guidelines. Using code books the medical coder assigns correct codes to record the service levels for the procedures performed and to account for supplies used to treat the patient during a health care service. Proper assignment of ICD-9-CM codes corresponds with the physician’s diagnoses and completes the the record of the patient’s illness or injury. Today, the medical coders audit and re-file appeals of denied claims, educate providers and recommend the appropriate application of mandates and compliance. The coder may also provide evidence for the provider and patient in issues of coverage and medical necessity.

CPT CODES

ICD9-CM

The International Classification of Diseases (most commonly known by the abbreviation ICD) is according to its publisher, the United Nations-sponsored World Health Organization "the standard diagnostic tool for epidemiology, health management and clinical purposes." It is known as a health care classification system that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this system, every health condition can be assigned to a unique category and given a code, up to six characters long. Such categories can include a set of similar diseases.

The International Classification of Diseases is published by the World Health Organization (WHO) and used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in health care. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. The ICD is a core classification of the WHO Family of International Classifications (WHO-FIC).

RxNORM

ICD10-CM

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), for medical coding and reporting in the United States. The ICD-10-CM is a morbidity classification for classifying diagnoses and reason for visits in all American health care settings. The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO) which replaces ICD-9.

The implementation of ICD-10 was delayed from October 1, 2013 to October 1, 2014 by final rule CMS-0040-F issued on August 24, 2012.

Until that time the codes in ICD-10-CM are not valid for use.

www.cdc.gov/nchs/icd/icd10cm.htm#10update

SNOMED CT

NDC

CCD

LOINC

MEANINGFUL USE

MQSA