...Introduction to ICD-10-CM/PCS The World Health Organization (WHO) is the entity that owns and publishes the International Classification of Diseases (ICD) system (The World Health Organization (WHO), 2013). The United States made modifications to this classification system and in 1979 implemented the use of ICD-9-CM. Since that time healthcare worldwide has evolved and the need to collect more detailed information regarding the diseases and conditions that effect world’s population has become a high priority. Due to this evolution, the ICD-9-CM system has become outdated and can no longer accommodate our needs. Effective October 1, 2014 the United States will implement ICD-10-CM/PCS for use across the nation. Initially we will cover ICD-10-CM and then address ICD-10-PCS. ICD-10-CM is the classification system to be utilized to record diagnoses identified and treated in both the acute care setting as well as the ambulatory setting. There are various differences between ICD-9-CM and ICD-10-CM and we will highlight several of those differences today. One difference between the two coding classification systems is the number of chapters. ICD-10-CM consists of twenty-one chapters as compared to the seventeen chapters in ICD-9-CM. There are approximately 68,000 diagnostic codes in ICD-10-CM as opposed to the 14,000 in ICD-9-CM (DeVault, Barta, & Endicott, 2012). The length and structure of the codes in ICD-10-CM vary greatly from ICD-9-CM. We have...
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...enters the information into the medical billing software, including doctor’s information, patient’s information, insurance information, medical billing codes, payment information, and any special notes on the account. Medical billing codes are necessary for a doctor to be properly reimbursed for the services provided. These codes are some of many: • ICD 9 codes (and ICD 10 codes)- international classification of diseases • CPT codes- current procedural terminology • CPT modifiers- these provide additional information to payers to make sure doctors get paid correctly for services provided • Medicare billing codes- explained for provider services and hospital insurance • CDT codes (dental)- code on dental procedures • NDC drug codes- national drug codes • DRG Medicare codes- diagnosis related group • Taxamony codes- used to categorize a provider or group specialty Our responsibility as Medical billers and coders • Collect the information necessary to prepare insurance claims and bill patients • Enter patient’s information and insurance information into the medical billing software • Enter patient’s special information including ICD 9 diagnosis codes and CPT medical billing codes • Interpret and post explanation of benefits (EOB) • Research, correct, and re-submit denied claims • Bill patients for their responsible portions • Answer patient’s questions...
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...the implementation of ICD-10 and the electronic health record. Progression is not only inevitable for the healthcare industry, but also for society as a whole. This results in increased workflow to ensure continuum of care is being met. A major concern that the health information management (HIM) industry is facing is inaccurate clinical documentation which contributes to coding errors. This causes increased claims rejection which can affect a facility’s revenue. As part of the ICD-10 transition, there is an expectation of high standards in processing medical records while enduring the massive amount of workload that comes along with thousands...
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...Thanks for an insightful post! While I agree that every phase of the revenue cycle like pre-authorization, scheduling, and registration will be impacted by the physicians’ use of accurate admission codes, I believe the impact goes far beyond just coding. The improvement in clinical documentation is one area that will affect the number of charts on hold at facilities for documentation issues like physician queries. This is critical especially in procedure coding where the interest is not the amount of documentation that the provider will or will not accumulate, but the specificity of that documentation (Arends-Marquez, Knight, & Thomas-Flowers, 2014). The ICD-10 transition has impacted every aspect of the RCM process making it more robust,...
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...Job description Inpatient Medical Coding Inpatient Medical Coding job involves coding charts for patients whose treatment requires hospitalization for more than 24 hours. Inpatient Medical Coders use the coding systems ICD-9-CM, ICD-10 as well as DRG (Diagnoses Related Groups). Inpatient Medical Coding requires greater knowledge and experience because the groupings and sequencing of codes for specific diagnoses and procedures in a hospital are significantly greater. Daily tasks usually include: • Review patient histories, operations, chart reviews, consultation and discharge summaries to support codes selected for billing. • Utilize ICD-9-CM and/or ICD-10 to select the diagnosis-related group (DRG) assignments for each case. • Identify mistakes in reports. • Enter coding information into electronic billing system. Many Inpatient Medical Coders work for hospitals, although insurance companies and long-term health-care facilities may also employ inpatient coders. They typically must have at least 2 years of experience to be hired and may work at the facility or off-site in their homes. Hours vary based on the employer. Accuracy is critical in this position, as much of a hospital’s revenue depends on the correct coding of the diagnoses, procedures, and treatments administered. Coders often interact with physicians, nurses and other medical professionals in order to select the proper codes. Critical thinking and communication skills, great attention to detail and the ability...
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...CD-10CM/PCS was mandated by CMS to take effect on October 1, 2014. Both ICD-10CM and ICD-10PCS include better detail, changes in terminology, and also expanded concepts for injuries, laterality, and other related factors. ICD-10CM has many structural changes from ICD-9CM. The differences are: ICD-9 has approximately 13,000 codes that are V.S. ICD-10 has about 68,000 codes and are 3 3 to 5 digits. to 7 digits long. ICD-9 first digit is either E or V or numeric ICD-10 first digit is alpha; 2nd and 3rd are numeric; 4th thru 7th are either ICD-9 lacks detail...
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...Summarize what it means to perform quality ICD-10-CM coding for the physicians' office. Performing quality ICD-10-CM coding for the physicians office is crucial because that is how payment is ensured. The patient is billed for the services provided at the hospital/clinic by the physician. The coder has to ensure that they are certified coders. Performing quality ICD-10-CM coding is when the coder codes everything properly. For a doctors visit, you could possibly have multiple symptoms where the physician has to run tests and examine you and then perhaps prescribe medication. If a coder were to try and write down every detail of the diagnosis then that report would be too long. With codes, diagnosis and procedures could be reported with sufficient information for the billers to then do their job efficiently. And because every code is verified a second time to ensure proper coding it makes it possible for the physician to receive reimbursement for...
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...of data codes. I results I wish to accomplish are the following: The Changes between ICD-9 and ICD-10 code sets. Differences between ICD-10-CM and ICD-10-PCS code sets. How ICD-10 coding could affect patient encounters. How the transition will affect departments. Regulatory requirements. Quality Improvement. Clinical Documentation Improvement. The challenges and barriers of ICD-10-CM/PCS coding transitions. Create a checklist for the staff. The font or typeface I will use or script-like fonts around 14, in bold those typically work better as heading fonts rather than body text and 12 for the body. I use of visuals communication would help me effectively deliver my message on the important issues with documentation and with the pictures and graphs, showing gains and loss of loss revenue would help them understand what is required for compliance and increase revenue. I will also show the standard required to be in compliances with The Joint Commission rule and regulations. The reason for my choice for training materials because is easiest way too explained and train the staff with all the new changes. These training sessions will be workshops and departmental in-services with custom design to fit each service needs. My training or transition would start with and introduction to explained in detail the new system of ICD-10 The ICD-10 Transition The ICD-9...
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...ICD 9 CODE Structure: ICD-9 is widely considered to be based on outdated technology, The current ICD-9-CM diagnosis codes do not provide sufficient clinical specificity to describe the severity of the patients disease conditions. The ICD 9 code system consist of 13,000 where the ICD 10 codes system consist of 68,000 and gives us patients more of a flexibility. (How ICD 9 is structured is below) - 3 to five character codes -The code structure varies, First digit may be alpha (E or V) or numeric but the digits after it are always numeric. The structure is into 3 volumes Volume 1 Tabular listing for Diagnosis Volume 2 Index to Disease for Diagnosis Volume 3 Index to Disease & Tabular list ICD 10 CM structure: There are more complete descriptions-In ICD-10-CM, the subcategory titles are usually complete so that the coder does not have to read previous codes to understand the meaning of the code.The increased specificity of the ICD-10-CM codes makes complete and accurate documentation increasingly important with the implementation of the new system....
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...Correct Medical Billing and Coding in the Healthcare Industry Medical billing and coding is one of today's topics. When services are billed for patients, they must be coded based on the documentation the physician has dictated in the patients chart to receive payment from the insurance company. As the physicians office and/or hospitals practice correct medical billing and coding, this will prevent audits being brought forth in their practice and/or hospital. Kenny, Christopher,Correct Coding for Dialysis Billing Providers must ensure proper coding to avoid returned claim, 2012. This article is geared for those in the medical field who do coding and billing in hospitals for dialysis. The author is educating the coders and billers how to correctly code for dialysis billing. He mentions that The Centers for Medicare and Medicaid, issued a transmittal that has revised the Medicare claims processing manual as it pertains to hospitals billing for dialysis procedures that are non covered under the ESRD benefit for emergency dialysis. In addition, the author discusses how the hospitals should utilize Healthcare Common Procedure Coding System billing code G0275 and code 90935 for hemodialysis. Only to bill G0275, if the hospital is a ESRD facility, emergency services, and when dialysis is performed with related procedures, such as a vascular access procedures or when performed following treatment for an unrelated medical emergency. The author also continues to...
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...World Health Organization established the International Classification of Diseases (ICD) to standardize medical records. ICD-10 is an update that reflects changing needs in medicine. The code offers increased detail and flexibility. However, implementing the code presents medical establishments with several challenges. The biggest challenge is finding common ground between the two frameworks. How ICD-10 Impacts Healthcare A presentation published by the Centers for Medicare and Medicaid Services explains that the World Health Organization created ICD-9 in 1979 to reflect current medical advances and establish universal coding procedures. [1] The system outlines the diagnoses, procedures and terminology used by caregivers. Medical organizations...
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...Classification Systems Catrina Lemus American International University April 3, 2011 Abstract The following paper will be discussing the 4 main steps to ensure that the ICD codes are accurate. This paper will also be discussing the four steps that are necessary to establish the proper ICD-9-CM code. There are many ways that this paper will explain what is right to do and gives you a good source through a book that you can just gather all your information from. Step-by Step Medical Code Book by Buck is such an incredible book to get your sources from. ICD-9-CM code means International Classification of Disease, 9th edition. This is a standardized classification of disease, injuries and causes of death, by etiology and anatomic localization and anatomic localization and codified into a 6 digit number. When given any of these symptom assigned number’s this allows many clinicians and many involved people that have the same common language with in the medical field. The ICD-9-CM has been used in this country since 1973 for morbidity applications. This will help continue the hospital or anyone dealing with medical to be organized and just improve more and more. There are 8 steps to follow to have an accurate coding system. We are going to discuss the top 4 that are important. First one is to identify the main term in the diagnostic statements meaning you would to make sure that you have the correct code. Always do a double check when finding the correct code. The second...
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...MENTAL ILLNESS October 2001, just after September 11, he started acting and behaving erratically. He was not the same man we have known as Uncle Dan for the past few years. What has happened to him? Has he suffered from some type of mental illness? According to Canadian Health Association “mental illnesses can take many forms, just as physical illnesses do” (Canadian Mental Health Association, 2009). Uncle Dan was born and raised in a small town named Quesnel, located in the South Western part of Canada. Although his parents were not wealthy, they were not financially restricted either, due to the abundance of lumber mills in this region. They had pushed and financed their children education, for they knew that it was an investment into the future. Even though Uncle Dan’s parent never received a formal education, they were fully aware of the importance of going to college. As an honor graduate from the local High school, Uncle Dan received a scholarship from the province university, BC University, to continue his education. That year, he had met Julia, my mother’s younger sister, whom he married a year later. Shortly afterward, Dan dropped out of the University and returned home to work in a local mill. The only explanation that was given to his parents was “College is not meant for people like me.” While this was not the extent of Uncle Dan’s transformation, it was not enough of a significant warning sign that Uncle Dan had a mental issue. In fact, it was not until that...
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...Assignment 2: Treatment of Mentally Ill Prisoners 1.0 The Treatment of Mentally Ill Prisoners The treatment of mentally ill inmates has been not only a public concern, but has also been identified by Canada’s Correctional Investigator, Howard Sapers as an issue of concern in his 2014 report to parliament. Between 1997 and 2007, offenders entering the prison system with a mental disorder grew 71% in men and 61% in women (Canadian Mental Health Association, 2012). The problem at hand is that correctional institutes and their staff are not widely trained to deal with inmates who suffer from mental disorders. The result then, is that use-of-force interventions, and placement in solitary confinement, often for extended periods of time, are used as methods of dealing with unruly behaviours exhibited by these mentally ill offenders. While there are various issues surrounding mental health in the Canadian judicial system, for the purpose of this report, the discussion will be focused around inadequate methods for dealing with behaviours presented by these inmates, namely by use-of-force and solitary confinement 1.1 Use-Of-Force Techniques In Sapers 2014 report, it is reported that “28% of all use of force interventions involved an offender with a mental health concern as identified by the Correctional Service of Canada (CSC)” (Ministry of Public Safety, 2014). This is likely due to the fact that mentally ill inmates are more likely to self-harm, have unpredictable behaviour...
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...The differences for icd-9-cm and icd-10-cm is that the ICD-9 contains approximately 13,000 codes, a daunting number to deal with already. ICD-10 will contain a total of approximately 68,000 available codes. ICD-9 coders and ICD-9 billers are professionally trained and certified to translate medical records into 13,000 codes. The structure of ICD-10 codes is greatly expanded and the new codes are capable of reporting data in much greater specificity. The granularity of data that ICD-10 codes contain is expected to improve the efficiency of healthcare reimbursement and reduce charges of fraud and abuse. Unlike ICD-9 codes, which are generally all numeric with the exception of rarely used V- and E- codes, ICD-10 billing will involve an all encompassing alpha-numeric systemization. The first character of an ICD-10 diagnosis code is always a letter. It is followed by at least two numbers. After that, the code can consist of zero to four other characters that can be a combination of numbers and letters. When most people talk about ICD-10, they are referring to ICD-10CM. This is the code set for diagnosis coding and is used for all healthcare settings in the United States. ICD-10PCS, on the other hand, is used in hospital inpatient settings for inpatient procedure coding. The career I want to pursue is medical Billing and coding in a doctor...
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