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Medical Coding, 2nd Edition

Book Description

In clear and straightforward language, Medical Coding: What It Is and How It Works, Second Edition provides an overview of the evolution of medical coding and all the various coding systems, how they relate, and how they function. Reasoning and consequences of the delayed ICD-10 implementation are explained along with a sound overview of the ICD-10-CM and PCS classification systems. For those contemplating a career in the coding field, this book is ideal as a basic orientation. Other individuals in healthcare management and administration will also benefit from a basic understanding of how coding works. Unlike other publications that focus only on coding, this book integrates coding guidelines and principles into the billing and reimbursement process, giving the student a more practical foundation in the rationale for correct coding. Healthcare fraud and abuse is addressed as well, to assure that readers understand ethical concerns inherent in coding for reimbursement. Instructor Resources: Instructor's Manual, PowerPoint slides, Test Bank

Table of Contents

  1. Cover
  2. Title Page
  3. Copyright
  4. Contents
  5. Introduction
  6. Acknowledgments
  7. Chapter 1 Medical Coding in History
    1. The Black Death
    2. William Farr and the Cholera Studies
    3. International List of Causes of Death
    4. Beyond Death
    5. Modern Times
    6. Reflection of Society
    7. Preparation for Coding Success
    8. References
  8. Chapter 2 Diagnosis Coding: A Number for Every Disease
    1. What Is a Diagnosis?
    2. Deducing the Diagnosis: History
    3. Deducing the Diagnosis: Exam
      1. Constitutional
      2. Eyes
      3. Ears, Nose, Mouth, and Throat
      4. Neck
      5. Respiratory
      6. Cardiovascular
      7. Chest (Breasts)
      8. Gastrointestinal (Abdomen)
      9. Genitourinary
      10. Lymphatic
      11. Musculoskeletal
      12. Skin
      13. Neurologic
      14. Psychiatric
    4. Reality Check
    5. Deducing the Diagnosis: Medical Decision Making
    6. Documenting the Diagnosis
    7. What Number Is My Diagnosis?
    8. How Hard Can This Be?
    9. What Are the Rules?
    10. Conventions: Section I.A.
    11. Instructional Notes: Section I.A.
    12. General Coding Guidelines: Section I.A.
    13. What Is the Structure of the Diagnosis Codes?
    14. Which Diagnosis Is Listed First?
      1. Inpatient
      2. Outpatient and Physician Office
    15. What’s in Each Diagnosis Chapter?
      1. Chapter 1: Certain Infectious and Parasitic Diseases (A00–B99)
      2. Chapter 2: Neoplasms (C00–D49)
      3. Chapter 3: Diseases of the Blood and Blood-Forming Organs (D50–D89)
      4. Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00–E89)
      5. Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01–F99)
      6. Chapter 6: Diseases of the Nervous System (G00–G99)
      7. Chapter 7: Diseases of the Eye and Adnexa (H00–H59)
      8. Chapter 8: Diseases of the Ear and Mastoid Process (H60–H95)
      9. Chapter 9: Diseases of the Circulatory System (I00–I99)
      10. Chapter 10: Diseases of the Respiratory System (J00–J99)
      11. Chapter 11: Diseases of the Digestive System (K00–K94)
      12. Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00–L99)
      13. Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00–M99)
      14. Chapter 14: Diseases of the Genitourinary System (N00–N99)
      15. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00–O9A)
      16. Chapter 16: Certain Conditions Originating in the Perinatal Period (P00–P96)
      17. Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00–Q99)
      18. Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00–R99)
      19. Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00–T88)
      20. Chapter 20: External Causes of Morbidity (V00–Y99)
      21. Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00–Z99)
    16. How Can You Code Your Conditions?
    17. Keeping Up-to-Date
    18. Misdiagnosis: The Wrong Path
    19. References
  9. Chapter 3 Procedure Coding: Location, Location, Location
    1. Coding Paths Diverge
    2. Hospital Procedures Versus Doctor’s Procedures
    3. Why the Difference? How Did It Come About?
      1. Hospital Procedure Coding
      2. Physician Procedure Coding
    4. What About HCPCS?
    5. Where It’s At
    6. ICD-10-PCS Procedure Coding Guidelines
      1. Hospital Inpatients Only
      2. Selection of Principal Procedure
      3. PCS Overview and Conventions
      4. Sections
    7. Medical- and Surgical-Related Sections (0–9)
      1. Medical and Surgical Section (0)
      2. Obstetrics Section (1)
      3. Placement Section (2)
      4. Administration Section (3)
      5. Measurement and Monitoring Section (4)
      6. Extracorporeal Assistance and Performance Section (5)
      7. Extracorporeal Therapies Section (6)
      8. Osteopathic Section (7)
      9. Other Procedures Section (8)
      10. Chiropractic Section (9)
    8. Ancillary Sections (B–D and F–H)
      1. Imaging Section (B)
      2. Nuclear Medicine Section (C)
      3. Radiation Therapy Section (D)
      4. Physical Rehabilitation and Diagnostic Audiology Section (F)
      5. Mental Health Section (G)
      6. Substance Abuse Treatment Section (H)
    9. PCS Body Part and Device Keys
    10. PCS Coding Challenges
    11. CPT Procedure Coding
    12. CPT Modifiers
    13. Additional CPT Coding Guidelines
      1. Anesthesia
      2. Surgery
      3. Radiology
      4. Pathology and Laboratory
      5. Medicine
      6. Evaluation and Management (E&M)
    14. Procedure Coding Summarized
    15. Up to the Minute
    16. References
  10. Chapter 4 How Codes Are Used for Reimbursement
    1. The Price Is Right
    2. Staking a Claim
      1. CMS-1500 Form or 837P (Professional) Format
      2. CMS-1450 or UB-04 Form or 837I (Institutional) Format
    3. Claims Submission
    4. Claims Processing and Adjudication
    5. The Rejection Puzzle
    6. Medical Necessity
    7. Payment Methodologies
      1. Fee for Service
      2. Reasonable Cost or Cost Based
      3. Prospective Payment: Inpatient Hospital
      4. Prospective Payment: Ambulatory Surgical Centers
      5. Prospective Payment: Skilled Nursing Facilities
      6. Prospective Payment: Home Health Agency
      7. Prospective Payment: Hospital Outpatient
      8. Risk-Adjusted Payment: Medicare Advantage Plans
    8. How Payment Methods Affect Coding
    9. References
  11. Chapter 5 Coding for Dollars
    1. Healthcare Fraud and Abuse
    2. OIG Compliance Guidance
    3. What Does This Have to Do with Coding?
    4. Preventive Measures
    5. References
  12. Chapter 6 Solving Your Healthcare Coding Problems
    1. Get a Life
    2. For the Record
    3. How Do Coding Errors Occur?
    4. When EOB = No
      1. 1. Contact the Provider
      2. 2. Contact the Insurer or Other Third-Party Payer
      3. 3. Request an Internal Review
      4. 4. Request an External Review
      5. 5. Contact the Provider Again
    5. References
  13. Chapter 7 Coding as a Career
    1. Is It Right for You?
    2. Where to Start?
    3. References
  14. Appendix A: List of ICD-10-CM Three-Character Diagnosis Categories
    1. 1. Certain Infectious and Parasitic Diseases
    2. 2. Neoplasms
    3. 3. Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism
    4. 4. Endocrine, Nutritional, and Metabolic Diseases
    5. 5. Mental and Behavioral Disorders
    6. 6. Diseases of the Nervous System
    7. 7. Diseases of the Eye and Adnexa
    8. 8. Diseases of the Ear and Mastoid Process
    9. 9. Diseases of the Circulatory System
    10. 10. Diseases of the Respiratory System
    11. 11. Diseases of the Digestive System
    12. 12. Diseases of the Skin and Subcutaneous Tissue
    13. 13. Diseases of the Musculoskeletal System and Connective Tissue
    14. 14. Diseases of the Genitourinary System
    15. 15. Pregnancy, Childbirth, and the Puerperium
    16. 16. Certain Conditions Originating in the Perinatal Period
    17. 17. Congenital Malformations, Deformations, and Chromosomal Anomalies
    18. 18. Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, NEC
    19. 19. Injury, Poisoning, and Certain Other Consequences of External Causes
    20. 20. External Causes of Morbidity
    21. 21. Supplementary Classification of Factors Influencing Health Status and Contact with Health Services
  15. Appendix B: General Equivalence Mapping (GEM) Files
    1. References
  16. Appendix C: Uniform Billing Revenue Codes
    1. How Hospitals Group Their Charges
    2. Accommodation Revenue Codes
    3. Ancillary Revenue Codes
    4. References
  17. Appendix D: Remittance Advice Claim Adjustment Reason Codes
    1. Tell Me Why
  18. Appendix E: Payment System Reference
  19. Appendix F: Useful Websites
  20. Appendix G: Uniform Hospital Discharge Data Set
    1. References
  21. Index