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Understanding Basic Medical Coding: Diagnosis and Procedure Codes Overview

This chapter provides an in-depth look at the fundamentals of medical coding, focusing on diagnosis and procedure codes. It covers the importance of utilizing ICD-9-CM for health information collection and statistical data compilation. Topics include the structure of diagnosis codes via the Tabular List and Alphabetical Index, as well as procedures for reporting services using Current Procedural Terminology (CPT) and HCPCS. Additionally, the chapter discusses methods for avoiding claims fraud and ensuring accurate coding practices to maintain integrity in healthcare billing.

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Understanding Basic Medical Coding: Diagnosis and Procedure Codes Overview

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  1. Chapter 14 Basic Coding

  2. Basic Coding • Basic coding • Diagnostic • Procedural • Medical coding • Ancillary diagnostic services • Ancillary therapeutic services

  3. Diagnosis Codes • ICD-9-CM • Using the ICD-9-CM • To facilitate the collection of health information • To compile statistical data • To index medical records • Chief complaint • Etiology • Principal diagnosis • Preexisting diagnosis • Coexisting condition

  4. Diagnosis Codes

  5. Diagnosis Codes

  6. Diagnosis Codes • Tabular list – Volume 1 • Divided by etiology and organ systems • Anatomical system or type of condition • Related groups of codes • Third digit • Fourth digit • Fifth digit

  7. Diagnosis Codes • Alphabetical Index – Volume 2 • Provides an index of disease descriptions in the tabular list • Provides an index in table format of drugs and chemicals that cause poisoning • Provides and index of external causes of injury, such as accidents

  8. Diagnosis Codes • Special Codes • V codes • E codes • Symbols • Square, bullet, triangle, facing triangle

  9. Procedure Codes • After an office visit, each procedure and service performed for a patient is reported on the healthcare claim using a procedure code • Using the Current Procedural Terminology (CPT ) • Locating correct codes • Add-on codes

  10. Procedure Codes • Modifiers • Symbols • (□) • (●) • (▲) • (►◄)

  11. HCPCS • The Healthcare Financing Administration Common Procedure Coding System is used to report procedures and services for patients • Level I codes • Level II codes • Level III codes

  12. Avoiding Fraud • Claims fraud occurs when physicians or others falsely represent services or charges to payers • Provider bills for services that were not provided • A patient exaggerates an injury to get a settlement from an insurance company or a medical assistant is asked to change a date on a patient’s chart so that a service is covered by a health plan

  13. Avoiding Fraud • Code linkage • Coding for coverage • Upcoding • Double billing • Correct coding initiative • Mutually exclusive codes

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