Codes

Module 2
 Assigning pre-defined
numeric or alpha-
numeric codes to a
patient’s medical
condition and provider’s
treatment
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 Why Medical coding?

• A simplified way of providing

accurate medical information to
Insurance companies for faster
processing and reimbursement.

• If medical records are submitted, it

would be tedious and time
consuming for the Insurance
companies to reimburse payments
based on it

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 Classification of Medical codes

Diagnosis codes Procedure codes

• Explains the reason for patient’s visit • Explains the treatment or checkup
/medical condition /disease of the done by the doctor; includes
patient. medicines & supplies.

• ICD-9-CM: International • HCPCS: Healthcare Common

Classification of Diseases –Ninth Procedure Coding System is the
Revision-Clinical Modification, standardized coding system for
provides codes to classify diseases describing all types of procedural
and a wide variety of signs, treatments given by physicians and
symptoms, health complaints, and hospitals.
external cause of injury or disease.

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 Types of ICD-9-CM codes
Explains the reason for patient’s visit /medical condition/disease of the patient.

E-codes V-codes
Numeric codes
(alpha-numeric codes) (alpha-numeric codes)

• Explains the medical • Explains the external • Explains encounters not

condition of the patient cause of injury (road as a result of injury or
(disease/injury/infection) accidents) illness (follow-up visit)

• Format: • Format: • Format:

123 E123 V12

123.1 E123.1 V12.1

123.12 V12.12

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 Code Ailments Category Examples
A few ICD-9-CM Codes
Diseases of the Nervous System 320-389 332.0 – Paralysis.

Numeri Diseases of the Circulatory System 390-459 429.2 - Cardiovascular disease.

c code
Diseases of the Digestive System 460-519
506.0 – Breathing trouble.

520-579 530.20 - Ulcer of esophagus without

Diseases of the Respiratory System
bleeding.

Persons with potential health hazards

V01-V06 V02.60 - Viral hepatitis carrier,
related to communicable diseases

Persons with potential health hazards V10.91 - Personal history of malignant

V- code related to personal and family history
V10-V19
brain tumor.

Persons encountering health services

V50-V59 V51.0 - Encounter for consultation.
for specific procedures and aftercare

E801.1 - Railway accident involving

Railway accidents E800-E807 collision with other object, passenger on
railway

E -code E821.6 – Non-traffic accident involving

Motor vehicle non-traffic accidents E820-E825 other off-road motor vehicle, pedal cyclist

E814.4 - Motor vehicle traffic accident

Motor vehicle traffic accidents E810-E819 involving collision with pedestrian,
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occupant of streetcar.
 POP Quiz!

Identify the appropriate ICD-9-CM codes:

history of certain breathing problems.

• Aftercare surgery.
• Railway accidents.
• Breathlessness.
• Paralysis of radial nerve.
• Observation and evaluation of new born.
• Bleeding from nose.
• Late effects of self inflicted injury.

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 Types of procedure codes
Explains the treatment or check up done by the doctor including medicines & supplies

CPT Codes HCPCS – Level II

• CPT - Current procedural • Healthcare common

terminology (HCPCS – procedure coding system
Level I) (HCPCS –Level II)

• Includes codes for: • Includes all services &

Surgery, Anesthesia, supplies that are not
Radiology, E&M, included in CPT.
Laboratory & Medicine (Injectable drugs)

• Format: • Format:

12345 (A-V)1234

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 CPT code category
Type of Service CPT Code Range Examples
00537 - Anaesthesia for cardiac
Anesthesiology 00100 to 01999
surgery
21270 - Augmentation, prosthetic
Surgery 10040 to 69990
material

76950 - Ultrasonic guidance for

Radiology 70010 to 79999
placement of radiation therapy

88302 - Surgical pathology

Pathology & Laboratory 80049 to 89399
procedure

95812 - Electroencephalogram [EEG]

Medicine 90281 to 9919
extended monitoring: 41-60 minutes

Evaluation & 99291 - Critical care, evaluation and

99201 to 99499
Management (E&M) management

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 HCPCS Level II Codes
Level II HCPCS codes represents products or
equipment.

A0428 Ambulance Service, Non-Emergency transport.

A0429 Ambulance Service, Emergency transport.

J1815 Injection, insulin, per 5 units.

D5640 Replace broken teeth-per tooth.

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 POP Quiz!

Identify the appropriate procedure codes:

• Family history of certain breathing
problems.
• Nasal sinus endoscopy.
• Ambulance service.
• Pacemaker for both the chambers of heart.
• Anesthesia for patient older than 70.
• Wheelchair and headrest with cushion.
• Injection for high temperature.
• Surgery on brain.
• In-patient consultation for
a new patient with medical examination

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 What are Modifiers?
Modifiers are used along with procedure codes to explain additional
information or any modifications done to the particular procedure.

LT Left side

RT Right side

TC Technical component

26 Professional component

50 Bilateral procedure (both sides)

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 Place of Service Codes
POS codes should be used in CMS 1500 to specify the place where service(s) were
rendered. This code will have an impact on insurance reimbursement.

21 Inpatient hospital

22 Outpatient hospital

23 Emergency room in hospital

11 Office visit

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 Learning check/ Try it yourself

• Is there a difference between a diagnosis

code and a procedure code?
• Will Insurance companies reimburse for
claims with incorrect coding. Substantiate.
• Is A9058 an valid CPT code? Substantiate
your answer.
• Why are modifiers attached only to
procedure codes?
• How important are place of service codes
in reimbursement of a claim payment.
• Identify a few causes for external injury ?
• Identify a few scenarios where V-codes
can be used?

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 Glossary
• Medical reimbursement: Act of compensating subscriber for an medical expense.
• Pre-defined : Already defined.
• Vaccinations: Vaccination is the use of vaccines (medicines) to prevent oneself from specific
diseases.
• Nervous system: The nervous system is responsible for carrying instruction from brain leading to
voluntary actions.
• Circulatory system: The circulatory system is an organ system that passes nutrients, hormones,
blood cells, etc. to and from cells in the body to help fight diseases and help stabilize body
temperature.
• Respiratory system : The primary function of the respiratory system is to supply the blood with
oxygen in order for the blood to deliver oxygen to all parts of the body.
• Hazards: A situation that poses a level of threat to life, health, property, or environment.
• Self inflicted injury: A self-inflicted wound (SIW), is the act of harming oneself.
• Injectable rugs: An injectable drug is an method of putting fluid into the body, usually with a
syringe and a hollow needle which is pierced through the skin to a sufficient depth for the
material to be administered into the body.
• Paralysis: The loss of the ability to move (and sometimes to feel anything) in part or most of the
body,

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