Medical Coding converts health care diagnosis of a disease, procedures, medical services, and equipment into universally accepted alphanumerical codes.
The diagnosis and procedure codes are taken from medical records documentation, such as transcription of physicians notes, laboratory and radiologic results, etc.( Medical chart)
In general, a patient visits a hospital with some problems. The doctor will give treatment; after that, he must be payable; but insurance companies will pay the physicians when coming to highly developed countries like the U.S, UK, etc. It is said to be Revenue cycle management.
REVENUE CYCLE MANAGEMENT:
PATIENT------->HOSPITAL--------->MEDICAL TRANSCRIPTION------->TEXT DOCUMENTS or ELECTRONIC MEDICAL RECORDS-------->MEDICAL CODES---------->MEDICAL BILLING-----> INSURANCE COMPANIES.
AAPC [AMERICA academy of professional coders] and AHIMA[American health information management association] offer certifications for medical coding.
Highest credentials from AAPC is CPC and from AHIMA is CCS
AAPC----->CPC------>ICD-10CM .
AHIMA------>CCS .
ICD-10 CM is an international classification of diseases 10th revision clinical modifications used for coding for conditions and diagnosis. Every year in October new set of ICD Codes are added, and some are removed (if necessary)by the WHO. To obtain a code, the coder must follow the basic guidelines of the ICD-10 CM Book.
These guidelines provide rules such as how to locate a code and obtain the level of detail.
1. Locating a code :
ICD-10CM is divided into 1) Alphabetical index
2) Tabular index
The coder must use both alphabetical and tabular lists. An alphabetical index does not always provide the complete code, and a tabular list provides the additional direction.
2. LEVEL OF DETAIL:
Codes are reported with the highest no. of characters available.
A code is invalid if it is not coded to the total no. of characters required for that code.
3. CODE or CODES FROM A00.0 Trough T88.9, Z 00- Z 99.8 :
The appropriate code or codes from A 00.0 through T 88.9, Z 00-Z99.8 must be used to identify diagnosis, symptoms, conditions, complaints, or other reasons for the visit.
4. SIGNS and SYMPTOMS:
Signs and symptoms codes are reported when that is known about a patient, and no definitive diagnosis has been made.
These codes may appear In a body system chapter when they only can be related to one body system .
5. CONDITIONS THAT ARE AN INTEGRAL PART OF A DISEASE :
Signs and symptoms that are associated routinely with a disease process should not assign a code.
6. MULTIPLE CODING FOR A SINGLE CONDITION :
In addition to the manifestation convention requiring two codes to describe a single condition that affects multiple body systems entirely, other single states also require more than one code.
MULTIPLE codes may be needed for sequela ( late effects of a disease) .
7. ACUTE AND CHRONIC CONDITIONS:
if a patient has both forms of the disease, both codes are assigned.
The acute or sub-acute code is sequenced first, followed by the chronic code for the disease.
8. COMBINATION CODE:
A single code to classify two diagnoses.
They are identified by reading all the includes and excludes notes in the tabular list.
It is assigned when one code fully describes the condition.
MULTIPLE coding should occur
They are used as a secondary code when the combination code lacks specificity in describing complications.
9. SEQUELLA OR LATE EFFECTS:
The code for the acute phase of an illness that led to the sequella is never used with a code.
Two exceptions to this rule. one coder should follow the codes as listed in the alphabetical index.
2. The primary term sequella must be used in the index to identify if a combination code for sequella and the underlying condition exists...
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