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MEDICAL CODING STANDARD |
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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. |
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CPT CODES |
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The Current Procedural Terminology (CPT) code set is maintained by
the American Medical Association through the CPT Editorial Panel. The CPT code set describes medical, surgical,
and diagnostic services and is designed to communicate uniform information about medical services and
procedures among physicians, coders, patients, accreditation organizations, and payers for
administrative, financial, and analytic purposes.
New editions are released each October. The current version is the CPT 2013. It is available in
both a standard edition and a professional edition.
CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS) as
Level 1 of the Health Care Procedure Coding System.
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page? |
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ICD9-CM |
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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). |
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RxNORM |
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RxNorm is a name of a US-specific terminology in medicine
that contains all medications available on US market. It can also be used in personal health
records applications. It is part of UMLS terminology and is maintained by National Library of Medicine.
RxNorm is two things: a normalized naming system for generic and branded drugs; and a tool for
supporting semantic inter-operation between drug terminologies and pharmacy knowledge base systems.
http://www.nlm.nih.gov/research/umls/rxnorm/overview.html
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ICD10-CM |
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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 |
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SNOMED CT |
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SNOMED CT (Systematized Nomenclature of Medicine -- Clinical Terms), is a systematically
organised computer processable collection of medical terms providing codes, terms, synonyms
and definitions covering diseases, findings, procedures, microorganisms, substances, etc. It allows
a consistent way to index, store, retrieve, and aggregate clinical data across specialties and sites
of care. It also helps in organizing the content of medical records, reducing the variability in the
way data is captured, encoded and used for clinical care of patients and research.
The primary
purpose of SNOMED CT is to support the effective clinical recording of data with the aim of
improving patient care. It is a structured collection of medical terms that are used internationally
for recording clinical information and are coded in order to be computer processable. It covers
areas such as diseases, symptoms, operations, treatments, devices and drugs. Its purpose is to
consistently index, store, retrieve, and aggregate clinical data across specialties and sites of care.
It helps organizing the content of electronic health records systems, reducing the variability in the
way data is captured, encoded and used for clinical care of patients and research. Specific language
editions are available which augment the international Edition and can contain language translations
as well as additional national terms.
SNOMED CT is considered by some to be the most comprehensive,
multilingual clinical healthcare terminology in the world. It provides for consistent information interchange
and is fundamental to an interoperable electronic health record. It can be used to record the clinical
details of individuals in electronic patient records and support application functionality such as informed
decision making, linkage to clinical care pathways and knowledge resources, shared care plans and as
such support long term patient care. The availability of free automatic coding tools and services, which
can return a ranked list of SNOMED CT descriptors to encode any clinical report, could help healthcare
professionals to navigate the terminology.
http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html |
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NDC |
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The National Drug Code (NDC) is a unique
product identifier used in the United
States for drugs intended for human use.
The Drug Listing Act of 1972 requires
registered drug establishments to
provide the Food and Drug Administration
(FDA) with a current list of all drugs
manufactured, prepared, propagated,
compounded, or processed by it for
commercial distribution. Drug products
are identified and reported using the
NDC.
http://www.fda.gov/drugs/informationondrugs/ucm142438.htm
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CCD |
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The Continuity of Care Document (CCD)
specification is an XML-based markup
standard intended to specify the
encoding, structure and semantics of a
patient summary clinical document for
exchange.
The CCD specification is a constraint on
the HL7 Clinical Document Architecture (CDA)
standard. The CDA specifies that the
content of the document consists of a
mandatory textual part (which ensures
human interpretation of the document
contents) and optional structured parts
(for software processing). The
structured part is based on the HL7
Reference Information Model (RIM) and
provides a framework for referring to
concepts from coding systems such as
from SNOMED and LOINC.
The patient summary contains a core data
set of the most relevant administrative,
demographic, and clinical information
facts about a patient's healthcare,
covering one or more healthcare
encounters. It provides a means for one
healthcare practitioner, system, or
setting to aggregate all of the
pertinent data about a patient and
forward it to another practitioner,
system, or setting to support the
continuity of care. Its primary use case
is to provide a snapshot in time
containing the pertinent clinical,
demographic, and administrative data for
a specific patient.
The CCD specification contains U.S.
specific requirements; its use is
therefore limited to the U.S. The U.S.
Healthcare Information Technology
Standards Panel has selected the CCD as
one of its standards.
CCD plays a key role in meaningful use.
Because it facilitates the sharing of
information between systems and
providers, it can be considered a
foundational element for complying with
many meaningful use criteria. Though it
is expected to play a much larger role
in future stages, the CCD is important
even in stage 1. |
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LOINC |
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Logical Observation Identifiers Names
and Codes (LOINC) is a database and
universal standard for identifying
medical laboratory observations. It was
developed and is maintained by the
Regenstrief Institute, a US non-profit
medical research organization, in 1994.
LOINC was created in response to the
demand for an electronic database for
clinical care and management and is
publicly available at no cost.
It is endorsed by the American Clinical
Laboratory Association and the College
of American Pathologists. Since its
inception, the database has expanded to
include not just medical and laboratory
code names, but also: nursing diagnosis,
nursing interventions, outcomes
classification, and patient care data
set.
www.nlm.nih.gov/research/umls/loinc_main.ht |
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MEANINGFUL USE |
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The Health Information Technology for
Economic and Clinical Health (HITECH)
Act of 2009 provides the Department of
Health & Human Services (HHS) with the
authority to establish programs to
improve health care quality, safety, and
efficiency through the promotion of
health IT, including electronic health
records and private and secure
electronic health information exchange.
Under HITECH, eligible health care
professionals and hospitals can qualify
for Medicare and Medicaid incentive
payments when they adopt certified EHR
technology and use it to achieve
specified objectives.
Meaningful use (MU), in a health
information technology (HIT) context,
defines the use of electronic health
records (EHR)
and related technology within healthcare
as mandated by the HITECH Act. Achieving
meaningful use also helps determine
whether an organization will receive
payments from the federal government
under either the Medicare EHR Incentive
Program or the Medicaid EHR Incentive
Program.
www.healthit.gov/policy-researchers-implementers/meaningful-use |
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MQSA |
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The Mammography Quality Standards Act (MQSA)
established national standards for
accreditation, certification, and
inspection of mammography facilities in
the U.S. This act ensures that women who
receive mammograms in the U.S. each year
receiving high-quality, consistent and
reliable breast imaging at mammography
facilities across the country.
Through this legislation, the FDA has
create an environment where nearly all
mammography facilities operate according
to national standards. These standards
have also helped optimize radiation
doses, and ultimately contribute to
improved detection, earlier treatment,
and better outcomes for breast cancer
patients.
The FDA’s implementation of MQSA has
ensured that health care providers and
equipment manufacturers seek to improve
quality and excellence in breast imaging
while giving women the information they
need to make better-informed health care
decisions.
www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/Regulations/ucm110906.htm |
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