General Inpatient Coding Guidelines

 A.   Use Of Both Alphabetic Index Tabular List

 

                  Use both the alphabetic and the index list when locating and assigning a code. Reliance on only the alphabetic index or the tabular list leads to errors in code assignments and less specificity in code selection.

 

                               Locate each term in the alphabetic index and verify the code selected in the tabular list. Read and be guided by instructional notations that appear in both the alphabetic index and the tabular list.

 

 B.   Level Of Specifying In Coding

 

Diagnostic and procedure codes are to be used at their highest level of specificity : 

 Assign three - digit codes only if there are no four - digit codes within that code category.

 Assign four - digit codes only if there is no fifth - digit sub classification for that category. 

 Assign four-digit codes only if there is no fifth-digit sub classification for that category.

 Assign the fifth-digit sub classification code for those categories where it exists. 

 

C.   Other (NEC) And unspecified (NOS) Code Titles

 

                                   Codes labeled "other specified (NEC not elsewhere classified) or "unspecified (NOS not otherwise specified) are used only when neither the diagnostic statement nor a through review of the medical record provides adequate information to permit assignment of a more specific code. 

                                   Use the code assignment for "Other" or NEC when the information at hand specifies a condition but no separate code for that condition is provided.

                                   Use "Unspecified" (NOS) when the information at hands odes not permit either a more specific or "Other" code assignment.  

                                    when the alphabetic index assigns a code to a labeled "Other(NEC)" or to a category labeled "Unspecified(NOS)", refer to the tabular list and review the titles and inclusion terms in the subdivisions under that particular three - digit category (or subdivision under the four - digit code) to determine if the information at hand can be appropriately assigned to a more specific code.

   

D.   Acute & chronic Conditions 

                                       If the same condition is described is as both acute (subacute) and chronic and separate subenteries exit in the alphabetical index at the  same indentation level, code  both and sequence the acute (Sub acute) code first. 

 

 E.   Combination Code 

                         1    A single code used to classify two diagnoses or a diagnosis with an associated secondary process (Manifestation) or an associated complication code. combination codes are identified by referring to sub term entries in the alphabetic index and by reading the inclusion and exclusion noted in the tabular list.

                          2     Assign only the combination code when that code fully identifies the diagnostic conditions involved or when the alphabetic index so directs. Multiple coding should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis. when the combination code lacks necessary specificity in describing  the manifestation or combination, an addition code may be used as a secondary code.

 

F.   Multiple Coding Of  Diagnoses

 

                  Multiple coding is required for certain condition not subject to the rules for combination codes.

                                 Instruction for conditions that require multiple coding appear in the alphabetic index and the tabular list.

 

                   1. Alphabetic Index :

                                  Code for both etiology and manifestation of a disease appear following the     sub entry term, with the second code in brackets.

                            Assign both code in the same sequence in which they appear in the alphabetic index .

                  2. Tabular List:

                                 Instructional terms, Such as"Code first", Use Additional Code for any", and " Note", indicate when to use more than one code.  " Code First Underlying Disease."

                           Assign the codes for both manifestation and underlying cause. The codes for manifestations cannot be used (Designated) as principal diagnosis.

                         "Use additional code, to identify manifestation, as" Assign also the code that identifies the manifestation, such as, but not limited to, the example listed. the codes for manifestations cannot be used (Designated) as principal diagnosis. 

  

                 3. Apply Multiple Coding Instructions Throughout The Classification:

                              Where appropriate, whether or not multiple coding appear in the alphabetic index or the tabular list. Avoid indiscriminate multiple coding or irrelevant information,such as symptoms or sign characteristic of the diagnosis.

G.   Late Effect

 

                                         A late effect is the residual effect (condition produced) after the acute the acute phase on an illness or injury has terminated. There is no time limit on when a late effect code can be used.

                                The residual may be apparent early, such as in cardiovascular accident cases, or it may occur month or years later, such as that due to a previous injury.

   Coding of late effects requires two codes:  

1. The residual condition or nature of the late effect

2. The cause of the late effect 

 

                                   The residual condition or nature of the late effect is sequenced  first, followed by the cause of the late effect,except in those few instances where the code for the late effect is followed by a manifestation code identified in the tabular list and title or the late effect has been expanded( at the fourth and fifth digit levels) to include the manifestation(s). 

                             1. Late Effects Of Cardiovascular Disease

                                  Category 438 is used to indicate conditions classifiable to categories 430-437 as the causes of late effects (neurologic deficits), they classified elsewhere.

                                    These "Late Effect" include neurologic deficits that persist after initial onset of conditions classifiable to 430-437.

                                    The neurologic deficits caused by cerebrovascular disease may be present from the onset or may arise at any time after the onset of the condition classifiable to 430-437.

                                 Codes from category 438 may be assigned on a health care record with codes from 430-437 if the patient has a current CVA and deficits from an old CVA.

                                    Assign code V12.59 ( and not a code from category 438) as an additional code for history of cardiovascular disease when no neurologic deficits are present.

 

H.  Uncertain Diagnosis

 

                                    If the diagnosis documented at the time of discharge is qualified as"probable","suspected", "likely","questionable", possible", or "still to role out ", code the condition as if it existed or was established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis. 

  

I.   Impending or Threatened Condition

 

Code any condition described at the time of discharge as "Impending" "Threatened" as follows:

                                   If it did not occur, reference the alphabetic index to determine if the condition has a subentery term of "impending" or "threatened" and also reference main term entries for Impending and for Threatened.

                                   If the subterms are not listed,code the existing forerunner condition(s) and not the condition described as Impending or Threatened.             

 

 

 

 

 

  

       

Medical Coding

 Medical Coding is a type of alpha and numeric code.Is the process of transforming the description of medical diagnoses and procedures into universal medical code numbers.

Medical coding is the 1st step process in the medical billing process and it involves Icd-9-CM(international classification disease-9-clinical modification) , CPT(Current procedural terminology) & HCPCS(healthcare common procedure coding system) codes.

                                                    Healthcare Cycle

Patient

                                              Þ                                                                     
Reception

Þ

Doctor

Þ

Transcription report (Audio file which is said by doctor)

Þ

Medical Coder (Of report Text file) need to coded

Þ

Medical Biller (Go for bill to payer)

Þ

Code file fill in form (HIPPA)

Þ

Payer:

*Denial (AR caller)

*Partial Pay

*Pay

Revenue Cycle Management 

Revenue cycle management (RCM) is the process that manage claims processing,payment and revenue generation.It entails using technology to keep track of the claims process at every points of its life, So the healthcare provider doing the billing can follow the process and address any issue,allowing for a steady stream of revenue.

The process includes keeping track of claims in the system, making sure payments are collected and addressing denied claims,Which can cause up to 90 percent of missed opportunity. 

RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using ICD-10. Time management and efficiency play large elements in RCM, and a physician’s or hospital’s choice of an EMR can be largely centered around how their RCM is implemented.

Healthcare Revenue Cycle Management
Physician/Medical Billing Companies	Hospitals
Demographics Entry/ Patient Registration Eligibility Verification Medical Coding Charge Entry A/R Follow-up Denial Management and Appeals Credit Balances Analytics and Reporting	Patient Access Scheduling and Pre-Registration including eligibility verification Registration Revenue Capture Charge Capture Medical Coding Receivables Management A/R follow-up Denial Management Self-pay follow-up

  

What does a Medical Coder Do?

It takes a good deal of education and training to become a skilled medical coder. To begin, coders must have a thorough knowledge of anatomy and medical terminology. It is also important to become familiar with different types of insurance plans, regulations,compliance and the coding community’s three critical resource 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 an encounter with the physician. Proper assignment of ICD-9-CM codes corresponds with the physician’s diagnoses and completes the “story” of the patient’s illness or injury.

Medical Coding Courses :

Medical Terminology

Medical terminology courses teach students the meaning, spelling and use of technical terms that are used in the medical field. You will learn how to relate these terms to the correct body structures, diagnoses and treatments as well as become familiar with their common abbreviations and acronyms.

Anatomy &physiology

Common topics covered in anatomy and physiology courses include the basic biology of the human body as well as the circulatory, skeletal, muscular and nervous systems. Once you have completed this course, you will be able to identify the different body systems and understand how organs function.

Define:

Anatomy is the study of the body plan of animals/ humans. In some of its facets, anatomy is closely related to the Embryology,Comparative anatomy & Comparative embryology, through common roots in evolution.
Human anatomy is important in medicine. Is the identification and description of the structures of living things,
Which is the branch of biology and medicine.

                                                  Divided into three broad area:
                                                           Human Anatomy                                         
                                                           Zootomy(Animal) Anatomy.                                       
                                                           Phytotomy (Plant) Anatomy.

Human Anatomy :

The human anatomy is the entire structure of a human being and comprise a head,neck,trunk (which includes the thorax and abdomen) two arms and hands and two legs and feet. Every part of the body is composed of various type of cells.

Human anatomy is subdivided into Gross anatomy and Microscopic anatomy.

Medical Billing.

Common topics in medical billing courses include how to create and submit invoices for insurance companies and how to follow up on reimbursement payments. Students who take these courses learn how to verify that healthcare documentation is accurate and meets legal and ethical requirements.

Internships and Externships

Internships and externships provide hands-on experience for students who are working toward an associates degree in medical billing and coding. These internships and externships are usually unpaid and last 3 to 6 months.