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
- Title Page
- Chapter 1 Medical Coding in History
Chapter 2 Diagnosis Coding: A Number for Every Disease
- What Is a Diagnosis?
- Deducing the Diagnosis: History
- Deducing the Diagnosis: Exam
- Reality Check
- Deducing the Diagnosis: Medical Decision Making
- Documenting the Diagnosis
- What Number Is My Diagnosis?
- How Hard Can This Be?
- What Are the Rules?
- Conventions: Section I.A.
- Instructional Notes: Section I.A.
- General Coding Guidelines: Section I.A.
- What Is the Structure of the Diagnosis Codes?
- Which Diagnosis Is Listed First?
What’s in Each Diagnosis Chapter?
- Chapter 1: Certain Infectious and Parasitic Diseases (A00–B99)
- Chapter 2: Neoplasms (C00–D49)
- Chapter 3: Diseases of the Blood and Blood-Forming Organs (D50–D89)
- Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00–E89)
- Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01–F99)
- Chapter 6: Diseases of the Nervous System (G00–G99)
- Chapter 7: Diseases of the Eye and Adnexa (H00–H59)
- Chapter 8: Diseases of the Ear and Mastoid Process (H60–H95)
- Chapter 9: Diseases of the Circulatory System (I00–I99)
- Chapter 10: Diseases of the Respiratory System (J00–J99)
- Chapter 11: Diseases of the Digestive System (K00–K94)
- Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00–L99)
- Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00–M99)
- Chapter 14: Diseases of the Genitourinary System (N00–N99)
- Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00–O9A)
- Chapter 16: Certain Conditions Originating in the Perinatal Period (P00–P96)
- Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00–Q99)
- Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00–R99)
- Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00–T88)
- Chapter 20: External Causes of Morbidity (V00–Y99)
- Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00–Z99)
- How Can You Code Your Conditions?
- Keeping Up-to-Date
- Misdiagnosis: The Wrong Path
Chapter 3 Procedure Coding: Location, Location, Location
- Coding Paths Diverge
- Hospital Procedures Versus Doctor’s Procedures
- Why the Difference? How Did It Come About?
- What About HCPCS?
- Where It’s At
- ICD-10-PCS Procedure Coding Guidelines
Medical- and Surgical-Related Sections (0–9)
- Medical and Surgical Section (0)
- Obstetrics Section (1)
- Placement Section (2)
- Administration Section (3)
- Measurement and Monitoring Section (4)
- Extracorporeal Assistance and Performance Section (5)
- Extracorporeal Therapies Section (6)
- Osteopathic Section (7)
- Other Procedures Section (8)
- Chiropractic Section (9)
- Ancillary Sections (B–D and F–H)
- PCS Body Part and Device Keys
- PCS Coding Challenges
- CPT Procedure Coding
- CPT Modifiers
- Additional CPT Coding Guidelines
- Procedure Coding Summarized
- Up to the Minute
Chapter 4 How Codes Are Used for Reimbursement
- The Price Is Right
- Staking a Claim
- Claims Submission
- Claims Processing and Adjudication
- The Rejection Puzzle
- Medical Necessity
- Fee for Service
- Reasonable Cost or Cost Based
- Prospective Payment: Inpatient Hospital
- Prospective Payment: Ambulatory Surgical Centers
- Prospective Payment: Skilled Nursing Facilities
- Prospective Payment: Home Health Agency
- Prospective Payment: Hospital Outpatient
- Risk-Adjusted Payment: Medicare Advantage Plans
- How Payment Methods Affect Coding
- Chapter 5 Coding for Dollars
- Chapter 6 Solving Your Healthcare Coding Problems
- Chapter 7 Coding as a Career
Appendix A: List of ICD-10-CM Three-Character Diagnosis Categories
- 1. Certain Infectious and Parasitic Diseases
- 2. Neoplasms
- 3. Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism
- 4. Endocrine, Nutritional, and Metabolic Diseases
- 5. Mental and Behavioral Disorders
- 6. Diseases of the Nervous System
- 7. Diseases of the Eye and Adnexa
- 8. Diseases of the Ear and Mastoid Process
- 9. Diseases of the Circulatory System
- 10. Diseases of the Respiratory System
- 11. Diseases of the Digestive System
- 12. Diseases of the Skin and Subcutaneous Tissue
- 13. Diseases of the Musculoskeletal System and Connective Tissue
- 14. Diseases of the Genitourinary System
- 15. Pregnancy, Childbirth, and the Puerperium
- 16. Certain Conditions Originating in the Perinatal Period
- 17. Congenital Malformations, Deformations, and Chromosomal Anomalies
- 18. Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, NEC
- 19. Injury, Poisoning, and Certain Other Consequences of External Causes
- 20. External Causes of Morbidity
- 21. Supplementary Classification of Factors Influencing Health Status and Contact with Health Services
- Appendix B: General Equivalence Mapping (GEM) Files
- Appendix C: Uniform Billing Revenue Codes
- Appendix D: Remittance Advice Claim Adjustment Reason Codes
- Appendix E: Payment System Reference
- Appendix F: Useful Websites
- Appendix G: Uniform Hospital Discharge Data Set
- Title: Medical Coding, 2nd Edition
- Release date: August 2014
- Publisher(s): Jones & Bartlett Learning
- ISBN: 9781284054583
You might also like
Excel 2016 For Dummies
Let your Excel skills sore to new heights with this bestselling guide Updated to reflect the …
Data-Driven Healthcare: How Analytics and BI are Transforming the Industry
Healthcare is changing, and data is the catalyst Data is taking over in a powerful way, …
Brilliant Project Management
Ensure that your projects succeed every time Whether you are organising an important event or heading …
Project Management: A Systems Approach to Planning, Scheduling, and Controlling, Tenth Edition
The landmark project management reference, now in a new edition Now in a Tenth Edition, this …