Universal Set Of Codes In Health Care Case Study

AAPC was founded in 1988 implement education and professional certification to physician-based medical coders to elevate standards of medical coding by administering training, certification, networking and job opportunities.

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.

This standardized dialect is also pertinent for medical schooling and teaching in addition to clinical research and studies conducted by scholars, scientists, and physicians by providing a valuable foundation for domestic and coast-to-coast operation evaluations. CPT is used to describe doctor’s services, a vast amount of administrative services in addition to operating services executed in medical facilities, treatment care centers, and outpatient divisions. Providing support for clerical duties and functions such as processing medical claims and initiating strategies and procedures for the evaluation of clinical care is another cause of relevance for CPT. The system also meets the need for tracking trends and identifying improvements, plus progression goals and scaling the value of healthcare services received by patients. The CPT coding system provides physicians throughout the United States with a consistent method for classifying and coding clinical procedures which in return provides a more efficient tool for recording and reporting task that were completed. Physicians, scholars and payors, have been dependent upon CPT to interconnect with other fellow associates, patients,

HCPCs is a collection of codes that represents the procedures, supplies, products, and services that may be provided to Medicare and Medicaid and to individuals enrolled in private health insurance programs. HCPCs are necessary for Medicare and Medicaid providers to provide healthcare claims that are managed consistently to get payment. Some of the settings you would use HCPCs codes would be in home healthcare, laboratory services, and dentist.

"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

Physicians and other facilities are paid by insurance companies, including Medicare and Medicaid, based on the procedure (CPT) code they submit. These codes must be accompanied by the correct diagnosis or ICD-10 codes.There must be a valid reason for a medical encounter for the physician to be paid, such as pain, refills for medications, or a follow-up for such diseases as diabetes or any chronic condition. If you just submit the CPT or ICD-10 code separately then you will not be paid as both support each other. So it is vital that a medical biller and coder be aware of these rules and how to complete the claim forms properly.

A. Discuss how you would carry out your various responsibilities as a coding manager by doing the following:

specific codes are charged to the patient and specific diagnoses entered on a claim for a patient.

Yes the time has arrives for all medical providers and practitioners must be in full compliance with the implementation of the ICD-10 coding system. What's so amazing is that many insurers offering assistance for the transition. According to Athena Health, they guarantee that their product will deliver a smooth transition by taking much of the preparation work off of the medical practice itself. Apparently they have devised a cloud-based service that is easier to use than the basic software programs commonly used. The costs for the transition is very expensive, In 2014, the Nachimson Advisers released a study estimating the cost of full implementation to ICD-10 for physician practices. In addition, The updated study estimated costs in

The coding compliance policy should include many procedures for the organization to follow. The first set of procedures should include specific guidelines for coding. Unique diagnosis and new medical procedures are utilized occasionally. Creating a plan to process these codes needs to be included by the coding manager. The policy should address what to do if there is not enough information to assign a correct code. The coding manager also needs to establish procedures for incorrect reported codes. Any incorrect code reported to a database needs to be corrected. Another procedure for coding included in the policy would be creating a mechanism to select optional codes for research purposes by the faculty. Providing oversight to the coding process is a necessary component to the compliance policy. The coding manager must create a method for auditing the department. The audit should also include an action

Coding systems are used in the inpatient and outpatient settings for the classification of patient morbidity and mortality information for statistical use. The World Health Organization (WHO) developed the Ninth Revision, International Classification of Diseases (ICD-9) in the 1970s to track mortality statistics across the world. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), is the adaptation the U.S. health system uses as a standard list of six-character alphanumeric codes to describe diagnoses. Globally utilizing a standardized system improves consistency in recording symptoms and diagnoses for payer claims reimbursement, as well as clinical research, and tracking purposes.

Coding consists of ICD-9-CM, ICD-10-CM, CPT and HCPCS codes. The codes help classify and document the information for the healthcare system in the United States. The ICD-9-CM stands for the International Classification of Diseases, Clinical Modifications. October 1st 2014 ICD-10-CM came out to update the class with more illnesses, conditions, and injuries of any patient that used the medical services. The ICD-9-CM is generally classified as numerical and alphanumerical codes with codes describing the illness and injuries. The CPT which is Current Procedural Terminology and the HCPCS which is the Healthcare Common Procedure Coding System are used in various medical settings. The CPT is published by the AMA yearly. CPT

of such a code need to be recognised . BMJ : British Medical Journal, 316(7142), 1458.

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.