Universal Medical Codes

HIPAA requires two designate coding system to be used to report to private and public payers; this is HCPCS and ICD-10. This coding system is primarily used in the United States and it is used by healthcare providers, including physicians and hospitals. Icd-10 is useful for reporting inpatient and HCPCS is used for procedure reporting for outpatient service and they are both assigned to DRG group. Once the health service is performed, charge captures are slips that are posted to a patient’s account that is processed as a batch order system. The key to the ordering system and charge capture is the “charge code” which is then reflected each service, procedure, supply item or drugs in the chargemaster (CDM). Medical claims fall into one of two types: CMS

The Current Procedural Terminology (CPT) codes, are codes a medical biller uses to report healthcare procedures and services. Both medical billers and providers use CPT codes as a way to communicate with insurance companies. Proper coding and documentaition is essential for reimbursement. Proper coding and documentation also makes the difference between full reimbursement and reduced reimbursement or even a denial. Each code that is sent to a payer on a claim, has to have supporting documentation. For example, if a patient is seen for a urianary tract infection and during the visit the patient receives a urianalysis, you would expect to see an order, the correct CPT code, and the results for a urinalysis in the patients chart. I have always

-Inpatient coders have certifications allowing them to work exclusively for hospitals or facilities. An expertise in medical record review is a must, along with an up to date status with coding rule changes, regulations and issues for medical coding, reimbursements and compliance under MS-DRG and Inpatient Prospective Payment Systems (IPPS). Coders should have experience as well as expert knowledge in abstracting information from medical records for ICD-9CM vol. 1-3, specialized payment in MS-DRG and IPPS.

.The purpose of the HCPCs , Level 2 alphanumeric codes are used to report services, supplies and equipment, such as walkers , wheel chairs , oxygen, medicines , provided to Medicare and Medicaid patients , for which no codes exist . HCPCs codes can also be required on non-Medicare and Medicaid patients, because some third-party payer's follow Medicare and Medicaid guidelines and may require that a HCPCs Level 2 code also known as G codes , be assigned. There are also certain HCPCs level 2 codes required by all payer's , such as drug codes also known as j codes. You would find these codes used in out-patient settings , rehabilitation services, doctor's offices , and you would also use them for supplies used , medications and or equipment

One of the greatest milestones in the United States health system is the use of electronic health records codes to ensure consistency in diagnosis and treatment procedures provided by physicians (Romano & Stafford 2011). The purpose of the case scenario of the sixteen year old female who visits the emergency department is to show how electronic health record coding is done and its impact on health reimbursement. The International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes are brought out well in the case study showing how they help in ensuring physician consistency in coding diagnosis and treatment procedures for the purpose of health reimbursement.

necessary because they are used primarily to identify products, supplies, and services not included in CPT codes such as drugs and

The E/M code's is a big important part in this process. Being a health care professional, using the medical code's. like medicare, medicaid, other private insurance to be reimbursement. If not using the right code, the doctor office, hospital, and urgent care. Will lose a lot of money. So using the right cpt code's insurance companies, office, hospital, and urgent care can be reimbursement correct. Cause CPT code's are formed with 5 digits.

The correct coding of claims is vital for informing the insurance payer of what exactly the patient is being treated for as well as the method of treatment the patient is undergoing. Be sure to use the correct diagnosis codes to describe the patient's symptoms or illnesses and the correct procedure codes to describe the patient's method of treatment. Use accurate CPT and HCPCS code modifiers to provide additional information about the service or procedure performed. The insurance payer can only make an accurate

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

Uninformative codes can create confusion to what the code details. This language needs to be clear and detailed so that the health care organizations can provide the best health care as possible. When codes are

Averill, Richard F. (1996). The Development of the ICD-10 procedure coding system (ICD-10-PCS): Draft. Wallingford, CT: 3M Health Information System.

In the daily changes of healthcare, health information technology is evolving rapidly. The generation of coding is making significant developments along the years as well. The 3M-encoder system provides number of essential options to coders in just one click. It provides sophisticated, easy-to-learn solution for accurate, complete, and compliant coding and grouping. Coders need to be acquainted with these references because they provide back up through the articles in each one of them. 3M Coding and Reimbursement System, 3M Coding Reference, and 3M Coding Reference plus have articles for coders to read and get answers to use the appropriate codes. (Prophet). Due

An accurate and specific documentation of universally accepted set of codes are important for the protection of healthcare providers as well as increased reimbursement for services received. These codes are for the validation of which services the patient received from their health care provider ( (Page, 2009). Having the correct codes in place insures the provider with the information needed by the health insurance carrier. Maintained by the AMA (American Medical Association), this universal numeric assignment is also used for developing guidelines for medical care review as well as data collection for medical education and research (Scott, 2013).

“A procedure document includes relevant information like the date of the procedure, the patient’s name, and his or her date of birth. More importantly, a procedure document includes the doctor’s diagnosis and the procedure performed.”(Medical Billing and Coding). They turn the medical coding into medical cost for that claims can process. They are also there to catch any errors such as making sure the correct diagnosis was made as well as no inaccurate information about the

There are literally thousands and thousands of medical codes in the health care field and probably one for just about every scenario, disease, and procedure you can imagine. I never knew just how interesting coding could be until I enrolled in the MBC associates program at Community Care College. If medical billing and coding is something you are interested in, I encourage you to visit my blog at jamiemjohnson.wordpress.com to find more interesting facts.