Standard Coding Systems

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	Standard Coding Systems

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Standardized Coding Systems

Today's standardized coding systems include Diagnosis Codes and Current Procedural Terminology (CPT®) and CPT-4® for specifying treatment (services rendered).

Diagnoses and procedures must be correctly linked when services are reported for reimbursement because payers analyze the combination of codes to determine the medical necessity before accepting and paying the charges. Claims must comply with all requirements and be documented according to the rules.

Medical Coders and Billers....

Commonly Used Diagnosis Coding Systems

• ICD-9

• ICD-9-CM (Volumes 1 and 2 only. Volume 3 contains Procedure codes)

• ICD-10

• ICPC-2 (Also includes reasons for encounter (RFE), Procedure codes and Process Of Care)

• NANDA

• Diagnostic and Statistical Manual of Mental Disorders (Psychiatric disorders only)

• Mendelian Inheritance in Man (Genetic diseases only)

• SNOMED (D axis)

CPT® Coding

CPT® is the most common coding methodology used in the USA. The CPT Editorial Panel is responsible for maintaining the CPT nomenclature; numerical codes.

These CPT numerical codes were first developed in 1966 by the American Medical Association (AMA) and then adopted by Health Care Financing Administration (HCFA) for medical, surgical, diagnostic, or psychiatric procedures.

HCFA provides health insurance for over 74 million Americans through Medicare, Medicaid and Child Health. The majority of these individuals receive their benefits through the Fee-for-Service delivery system, however, an increasing number are choosing managed care plans.

CPT is Divided into 6 Sections:

CPT® is also useful for administrative purposes such as claims processing and for the development of guidelines for medical care review.

(1) evaluation and management

(2) anesthesiology

(3) surgery

(4) radiology

(5) pathology and laboratory

(6) medicine

Add-on codes and modifiers may also be selected.

CPT Category III

CPT Category III codes are a temporary set of tracking codes to identify new and emerging technologies. These are codes intended to facilitate data collection for and the assessment of, new services and procedures to substantiate widespread usage and clinical efficacy. They are also used to code for procedures that are still in the FDA approval process.

Remember!

Important is to know that these codes change annually and that CPT codes (services rendered) have to match the ICD codes (diagnosis) to justify medical necessity!

ICD-9, ICD-9-CM and ICD-10

International Classifications of Diseases (ICD): The ICD-10 is copyrighted by the World Health Organization (WHO), which owns and publishes the classification. WHO has authorized the development of an adaptation of ICD-10 for use in the United States for U.S. government purposes. As agreed, all modifications to the ICD-10 must conform to WHO conventions for the ICD.

ICD-9 is used to code and classify mortality data from death certificates.

ICD-9-CM is for patient diagnoses. It consists of a numerical list of the disease code numbers, an alphabetical index to the disease entries and a classification system for surgical, diagnostic and therapeutic procedures.

ICD-10 is a completely new coding system proposed for reimbursement purposes.

ICD-10-PCS is being developed as a replacement for ICD-9-CM.

ICD-10-PCS Coding System and Training Manual

ICD-10-CM was developed following a thorough evaluation by a Technical Advisory Panel and extensive additional consultation with physician groups, clinical coders, and others to assure clinical accuracy and utility. However, the codes in ICD-10-CM are not currently valid for any purpose or uses.

The American Hospital Association (AHA) and the American Health Information Management Association (AHIMA) conducted a joint testing of ICD-10-CM using this pre-release version. Read AHIMA Press Release:

ICD-10 CAN HELP REDUCE FRAUD

Additional Codes and Modifiers

Modifiers

HCPCS (Healthcare Common Procedure Coding System)

Temporary codes

E&M codes

DSM-IV codes used only in psychotherapy

These codes and modifiers assist physicians, health providers who are managed care, as well as Medicare carriers and other insurance companies in the assignment of reimbursement amounts.