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MO230 Chapter 001
1. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 1
The Rationale for and History of
Coding
2. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
2
Lesson 1.1: The Rationale for and
History of Coding
๏ Describe the application of coding.
๏ Define nomenclature and classification.
๏ Identify the historical timeline of coding.
๏ Explain the difference between ICD-9-CM and ICD-
10-CM.
๏ Delineate coder training needs for transitioning to
ICD-10-CM.
๏ Describe the different coding organizations and
credentials.
3. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
3
Lesson 1.1: The Rationale for and
History of Coding
๏ Recognize the importance of the Standards of
Ethical Coding.
๏ Define compliance as it relates to coding.
๏ Explain confidentiality as it relates to coding.
4. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
4
Background of Coding
๏ What is coding, and what are its applications?
๏ International Classification of Diseases, 10th
Revision, Clinical Modification (ICD-10-CM &
ICD-10-PCS)
๏ Medicare Severity Diagnosis-Related Groups
(MS-DRGs)
5. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
5
Background of Coding
๏ Nomenclature
๏ Classification
๏ Types of
๏ History of
6. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
6
History of Coding
๏ 1893: Bertillonโs Classification of Causes of
Death
๏ 1898: Adopted by the American Public Health
Association
๏ World Health Organization (WHO)
๏ International Classification of Causes of Death
๏ 1977: Clinical Modifications (CMs) for U.S.
7. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
7
History of Coding
๏ 1993: ICD-10 published by the WHO
๏ In use in other countries
๏ Alphanumeric system
๏ Implementation in the U.S. slated for October
2014
8. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
8
History of Coding
๏ ICD-9-CM updated twice a year
๏ Federal Register publication of updates
๏ See www.cms.gov
๏ Current coding tools are a must!
9. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
9
History of Coding
๏ Development & maintenance of guidelines:
๏ National Center for Health Statistics (NCHS)
๏ Centers for Medicare and Medicaid Services
(CMS)
๏ American Hospital Association (AHA)
๏ American Health Information Management
Association (AHIMA)
10. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
10
Preparation for Transition to ICD-10-
CM
๏ Differences between ICD-10-CM & ICD-9-CM
๏ Increase in the number of codes and code
categories
๏Change from numeric to alphanumeric
๏Increase in digits from 5 to 7
๏Increase from 17 chapters to 21 chapters
11. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
11
Preparation for Transition to ICD-10-CM
๏ Coders must have in-depth knowledge of
๏ Anatomy and physiology
๏ Medical terminology
๏ Operative reports
๏ ICD-10-PCS definitions
12. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
12
Coding Organizations and
Credentials
๏ Where do coders work?
๏ Hospitals
๏ Physician offices
๏ Outpatient surgical centers
๏ Long-term care facilities
๏ Insurance companies
๏ Prisons
๏ Government agencies
13. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
13
Coding Organizations and
Credentials
๏ American Health Information Management
Association (AHIMA) Credentials:
๏ CCA Certified Coding Associate
๏ CCS Certified Coding Specialist
๏ CCS-P Certified Coding Specialistโ
Physician-Based
๏ RHIT Registered Health Information
Technician
๏ RHIA Registered Health Information
Administrator
14. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
14
Coding Organizations and
Credentials
๏ American Academy of Professional Coders
(AAPC) Credentials:
๏ CPC Certified Professional Coder
๏ CPC-H Certified Professional Coderโ
Hospital-Based
๏ CPC-P Certified Professional Coderโ
Payer-Based
15. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
15
Coding Organizations and
Credentials
๏ Certification examinations
๏ Keeping coding knowledge current
๏ Continuing education units (CEUs)
๏ Minimums are required to maintain certification
16. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
16
Coding Organizations and
Credentials
17. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
17
Coding Ethics
๏ AHIMA and AAPC have standards for ethical
coding
๏ Examples:
๏ Coding professionals should adhere to coding
guidelines
๏ They should only assign and report codes that are
supported by physician documentation
๏ They should maintain and enhance coding skills
18. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
18
Coding Ethics
19. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
19
Compliance
๏ Follow the rules!
๏ Who makes the rules?
๏ CMS
๏ State agencies
๏ Joint Commission
๏ Increase in compliance programs
๏ Health Insurance Portability and Accountability Act
of 1996 (HIPAA)
๏ Increase in compliance officers
20. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
20
Compliance
๏ Make sure you and your department are in
compliance
๏ Steps to ensure compliance
๏ Have a coding compliance plan
๏ What should be in the plan?
21. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
21
Confidentiality
๏ Covered in:
๏ Patient Bill of Rights
๏ HIPAA
๏ Common sense/need-to-know approach
22. Copyright ยฉ 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
22
QUESTIONS
Editor's Notes
Medical coding consists of translating diagnoses and procedures into numbers for the purpose of statistically capturing data.
A nomenclature is a system of names that are used as preferred terminology (in this case, for diseases and procedures). Classification systems group together similar items for easy storage and retrieval. The ICD-10-CM classification system is a closed system that comprises diseases, injuries, surgeries, and procedures. In a closed classification system a disease, condition, or procedure can only be classified in one place.
ICD-9-CM, a publication of the U.S. Department of Health and Human Services, consists of 3 volumes.
ICD-10-CM will replace ICD-9-CM, which has been in use for 30 years. The final rule for adoption of ICD-10-CM and ICD-10-PCS was released in January 2009. ICD-10 Tabular Volume was published in 1992. ICD-10 Instructional Volume was published in 1993. ICD-10 Alphabetic Index was published in 1994.
ICD-9-CM Coordination and Maintenance Committee meets twice a year. Upon full implementation of ICD-10-CM/PCS this will become the ICD-10 Coordination and Maintenance Committee. 2 Federal agencies are responsible for maintenance of ICD-9-CM: NCHS โ Classification of diagnoses CMS โ Classification of procedures
Along with above knowledge, also educate on the following: Structure change Disease classification Definitions Guidelines ICD-10-PCS
Most coders take certification examinations to earn credentials and become members of a professional organization.
See Table 1-2 in this chapter to see how many CEUs are required per year.
