This presentation was shared with an audience at the AHLA Fundamentals of Health Law program in November 2008. It contains some basic coding and compliance information to introduce health lawyers to the coding world including recent hot topics under scrutiny.

1. Coding and Reimbursement Basics for Lawyers : Understanding our (not so) little corner of the healthcare industry… American Health Lawyers Association

7. History of Diagnosis Coding Source: CMS “ Diagnosis Coding Using the ICD-9-CM ” CMS Proposes to replace ICD-9-CM with ICD-10 by Oct. 2011! 2008 The coding and reporting requirements published in 1994 by the Centers for Medicare & Medicaid Services (CMS) outlined basic steps that physicians should use to ensure correct coding. 1994 Since the passage of the Medicare Catastrophic Coverage Act of 1988, providers have been required to submit a diagnosis code on claim forms in order to receive reimbursement. 1988 The ICD-9-CM, or International Classification of Diseases, Ninth Revision, Clinical Modification, was published for use in 1979. 1979 The ICD-9 (without the CM for Clinical Modification) was used for coding in the U.S. from 1948 to 1979. 1948 Some form of medical diagnostic coding dates back to 17th-century England. 1600s

10. The Coding System: At A Glance ICD-9-CM Used to describe WHY services are rendered Volume 1: Tabular listing of medical conditions, causes and/or status Volume 2: Alphabetic index (Used first in locating condition in Volume 1) Procedure Codes Used to describe WHAT services/ supplies provided HCPCS (For other than hospital inpatients) ICD-9-CM Volume 3 (For hospital inpatients) HCPCS Level 1 CPT Codes (AMA) HCPCS Level 2 HCPCS (CMS, BCBSA, AHIP) Category 1 Items commonly accepted in clinical practice Category II Used to track performance measures Category III New and emerging technologies

32. Questions?