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Questions and Answers
What was established in 1946 by the International Commission of the World Health Organization?
What was established in 1946 by the International Commission of the World Health Organization?
The Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD).
When did the United States adopt the ICD-10-CM diagnostic coding?
When did the United States adopt the ICD-10-CM diagnostic coding?
October 1, 2015.
How does diagnostic coding relate to medical necessity?
How does diagnostic coding relate to medical necessity?
The diagnostic code tells the insurance company why a procedure was done.
What is a unique characteristic of the ICD-10-CM code structure?
What is a unique characteristic of the ICD-10-CM code structure?
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The ICD-10-CM coding manual has a fixed structure regardless of the publisher.
The ICD-10-CM coding manual has a fixed structure regardless of the publisher.
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What does the ICD-10-CM Alphabetic Index contain?
What does the ICD-10-CM Alphabetic Index contain?
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What is the importance of understanding coding conventions?
What is the importance of understanding coding conventions?
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What do the ICD-10-CM Official Guidelines for Coding and Reporting provide?
What do the ICD-10-CM Official Guidelines for Coding and Reporting provide?
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What does abstracting a diagnostic statement involve?
What does abstracting a diagnostic statement involve?
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What are the basic steps required for accurate ICD-10-CM coding?
What are the basic steps required for accurate ICD-10-CM coding?
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How can encoder software assist in assigning diagnostic codes?
How can encoder software assist in assigning diagnostic codes?
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Why is it important to adhere to coding guidelines?
Why is it important to adhere to coding guidelines?
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What should coders do when faced with discrepancies in reference sources?
What should coders do when faced with discrepancies in reference sources?
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What can be the consequence of unethical coding practices?
What can be the consequence of unethical coding practices?
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Study Notes
Historical Use of ICD
- Established by WHO in 1946 as a system to classify diseases and injuries.
- ICD-9-CM was adopted in the U.S. in 1975, with ICD-10-CM implemented on October 1, 2015.
- Diagnostic codes are crucial for insurance reimbursement; mismatched codes can lead to denials based on medical necessity.
Structure and Format of ICD-10-CM
- Format varies slightly based on the publisher; however, the foundational structure remains consistent.
- Codes start with an alphabetic letter indicating the disease chapter; 'U' is reserved for new diseases.
- Most codes consist of 7 alphanumeric characters, with periods separating groupings.
Using the Alphabetic Index
- The Alphabetic Index includes diagnostic terms, with main terms and modifiers.
- Main terms appear in bold; nonessential modifiers are in parentheses, while essential modifiers are indented.
- A hyphen indicates that additional characters are needed for complete code assignment.
Using the Tabular List
- Organized into 21 chapters and subcategories with 3-character codes.
- Chapters group diseases by type, body systems, or disease process.
- Example: Chapter 1 encompasses infectious diseases (A00-B99), while Chapter 15 focuses on pregnancy and childbirth (O00-O9A).
Coding Conventions
- Conventions guide coders through abbreviations, symbols, and instructional notes found primarily in the Tabular List.
- Understanding conventions is essential for accurate coding and avoiding errors.
Official Coding Guidelines
- Guidelines accompany the ICD-10-CM coding manual, offering rules for accurate code assignment.
- These guidelines complement conventions and add specificity to coding practices.
Abstracting Diagnostic Statements
- Medical assistants must analyze health records to abstract diagnostic statements for coding.
- Sources include encounter forms, treatment notes, discharge summaries, and various reports.
Steps for Diagnostic Coding
- Follow an eight-step process beginning with abstracting the diagnostic statement.
- Use the Alphabetic Index to locate relevant codes, confirming accuracy with the Tabular List.
- Knowledge of ICD-10-CM is vital for effective coding and impacts the practice's financial health.
Role of Encoder Software
- Encoder software aids coders in identifying the most accurate codes through a search function.
- Coders input keywords, and the software proposed relevant codes linked to the Tabular List.
Importance of Coding Guidelines
- Manuals provide detailed instructional notes to support accurate code selection.
- Coders must resolve discrepancies using the latest coding manual as the definitive source.
- Highest level of specificity in coding maximizes third-party reimbursements.
Ethical Standards in Medical Coding
- Pressure to engage in fraudulent coding practices exists, yet adhering to ethical standards is essential.
- Convictions of fraud can lead to loss of licensing for practices and fines for coders.
- Recognition of unethical coding behaviors is crucial for maintaining industry integrity.
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Description
This quiz focuses on the historical context of the International Classification of Diseases (ICD) in the United States and its relation to diagnostic coding and medical necessity. Test your knowledge on crucial medical coding concepts and their applications in healthcare.
