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Chapter 14

Chapter 14. Basic Coding. Basic Coding. Basic coding Diagnostic Procedural Medical coding Ancillary diagnostic services Ancillary therapeutic services. Diagnosis Codes. ICD-9-CM Using the ICD-9-CM To facilitate the collection of health information To compile statistical data

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Chapter 14

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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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