MO230 Chapter 001
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Transcript of MO230 Chapter 001
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Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 1The Rationale for and History of
Coding
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Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.2
Lesson 1.1: The Rationale for and History of Coding
Describe the application of coding. Define nomenclature and classification. Identify the historical timeline of coding. Explain the difference between ICD-9-CM and ICD-
10-CM. Delineate coder training needs for transitioning to
ICD-10-CM. Describe the different coding organizations and
credentials.
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Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.3
Lesson 1.1: The Rationale for and History of Coding
Recognize the importance of the Standards of Ethical Coding.
Define compliance as it relates to coding. Explain confidentiality as it relates to coding.
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Background of Coding
What is coding, and what are its applications? International Classification of Diseases, 10th
Revision, Clinical Modification (ICD-10-CM & ICD-10-PCS)
Medicare Severity Diagnosis-Related Groups (MS-DRGs)
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Background of Coding
Nomenclature Classification
Types of History of
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History of Coding
1893: Bertillon’s Classification of Causes of Death
1898: Adopted by the American Public Health Association
World Health Organization (WHO) International Classification of Causes of Death
1977: Clinical Modifications (CMs) for U.S.
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Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.7
History of Coding
1993: ICD-10 published by the WHO In use in other countries Alphanumeric system Implementation in the U.S. slated for October
2014
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History of Coding
ICD-9-CM updated twice a year Federal Register publication of updates
See www.cms.gov Current coding tools are a must!
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Copyright © 2014, 2013, 2012 by Saunders, an imprint of Elsevier Inc. All rights reserved.9
History of Coding
Development & maintenance of guidelines: National Center for Health Statistics (NCHS) Centers for Medicare and Medicaid Services
(CMS) American Hospital Association (AHA) American Health Information Management
Association (AHIMA)
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Preparation for Transition to ICD-10-CM
Differences between ICD-10-CM & ICD-9-CM Increase in the number of codes and code categoriesChange from numeric to alphanumericIncrease in digits from 5 to 7Increase from 17 chapters to 21 chapters
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Preparation for Transition to ICD-10-CM
Coders must have in-depth knowledge of Anatomy and physiology Medical terminology Operative reports ICD-10-PCS definitions
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Coding Organizations and Credentials
Where do coders work? Hospitals Physician offices Outpatient surgical centers Long-term care facilities Insurance companies Prisons Government agencies
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Coding Organizations and Credentials
American Health Information Management Association (AHIMA) Credentials: CCA Certified Coding Associate CCS Certified Coding Specialist CCS-P Certified Coding Specialist–
Physician-Based RHIT Registered Health Information
Technician RHIA Registered Health Information
Administrator
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Coding Organizations and Credentials
American Academy of Professional Coders (AAPC) Credentials: CPC Certified Professional Coder CPC-H Certified Professional Coder–
Hospital-Based CPC-P Certified Professional Coder–
Payer-Based
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Coding Organizations and Credentials
Certification examinations Keeping coding knowledge current
Continuing education units (CEUs) Minimums are required to maintain certification
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Coding Organizations and Credentials
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Coding Ethics
AHIMA and AAPC have standards for ethical coding
Examples: Coding professionals should adhere to coding
guidelines They should only assign and report codes that are
supported by physician documentation They should maintain and enhance coding skills
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Coding Ethics
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Compliance
Follow the rules! Who makes the rules?
CMS State agencies Joint Commission
Increase in compliance programs Health Insurance Portability and Accountability Act
of 1996 (HIPAA) Increase in compliance officers
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Compliance
Make sure you and your department are in compliance
Steps to ensure compliance Have a coding compliance plan What should be in the plan?
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Confidentiality
Covered in: Patient Bill of Rights HIPAA
Common sense/need-to-know approach
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QUESTIONS