Types of medical coding
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This document provides an overview of common medical coding systems used in the United States. It discusses the International Classification of Diseases (ICD), Current Procedural Terminology (CPT) codes, and Healthcare Common Procedure Coding System (HCPCS). ICD codes are used for diagnoses. CPT codes document medical procedures and services performed by physicians. HCPCS codes include additional medical items and services not covered by ICD or CPT codes, such as durable medical equipment. The document provides details on the purpose and guidelines for each coding system.
Types of medical coding
- 3. Medical Coding International Classification of Diseases IDC Current Procedural Terminology CPT Healthcare Common Procedure Coding System HCPCS
- 4. Medical Coding ɤ Diagnostic codes that create a uniform vocabulary for describing the causes of injury, illness and death. ɤ Established by the World Health Organization (WHO) in the late 1940s. ɤ Updated several times in the 60 – plus years since its inception ɤ The number following “ICD” represents which revision of the code is in use.
- 5. Medical Coding ɤ Are used to document the majority of the medical procedures performed in a physician's office. ɤ The code set is published and maintained by the American Medical Association (AMA). ɤ These codes are copyrighted by the AMA and are updated annually.
- 6. Medical Coding ɤ The Clinical Modification significantly increases the number of codes for diagnosis. ɤ The increased scope gives coders much more flexibility and specificity, which is essential for the profession. ɤ The ICD-10 code, has 14,000 codes. ɤ Its clinical modification, ICD-10-CM, contains over 68,000.
- 7. Medical Coding ɤ CPT codes are five-digit numeric codes. ɤ The first category is divided into six ranges which correspond to six major medical fields: Evaluation and Management Anesthesia Radiology Surgery Medicine Pathology and Laboratory
- 8. Medical Coding ɤ The second category of CPT codes corresponds to performance measurement and in some cases, laboratory or radiology test results. ɤ The five-digit, alphanumeric codes are typically added to the end of a Category I CPT code with a hyphen. ɤ The third category of CPT codes corresponds to emerging medical technology.
- 9. Medical Coding ɤ CPT codes also have addendums that increase the specificity and accuracy of the code used. ɤ CPT Modifiers are two-digit numeric or alphanumeric codes that are added to the end of the category I CPT code. ɤ They provide important additional information to the procedure code. ɤ E.g. a CPT modifier that describes which side of the body a procedure is performed on, and there’s also a code for a discontinued procedure.
- 10. Medical Coding ɤ This includes durable medical equipment, prosthetics, ambulance rides, and certain drugs and modifiers. ɤ HCPCS is also the official code set for outpatient hospital care, chemotherapy drugs, Medicaid, and Medicare, among other services. ɤ Since HCPCS codes are involved in Medicaid and Medicare, its one of the most important code a medical coder can use.
- 11. Medical Coding ICD-10-CM guidelines The Centers for Medicare & Medicaid Services (CMM) website Medical dictionary Novitas Solutions website
- 12. Medical Coding ɤ Read all four sections of the current ICD-10-CM Official Guidelines for Coding and Reporting. Section I. Conventions, general coding guidelines and chapter specific guidelines. Section II. Selection of Principal Diagnosis. Section III. Reporting Additional Diagnosis. Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services.
- 13. Medical Coding ɤ Describes structure and conventions of the classification and general guidelines that apply to the entire classification, and chapter-specific guidelines that correspond to the chapters as they are arranged in the classification. 1 •Conventions for the ICD-10-CM 2 •General Coding Guidelines 3 •Chapter-Specific Coding Guidelines
- 14. Medical Coding ɤ Section II includes guidelines for the selection of principal diagnosis for non-outpatient settings. ɤ Section III includes guidelines for reporting additional diagnosis in non-outpatient settings. ɤ Section IV is for outpatient coding and reporting