Module 5 ICD Coding

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Questions and Answers

What is the primary function of clinical coding in healthcare?

  • Converting narrative descriptions of diseases and procedures into alphanumeric codes for standardized data storage and analysis. (correct)
  • Developing new pharmaceutical treatments based on genetic sequencing of pathogens.
  • Creating diagnostic tests using biochemical markers to identify various disease states.
  • Translating healthcare data into multiple languages for international collaboration.

Which factor most significantly contributes to the necessity of clinical coding in healthcare?

  • To create a billing process for patients, dependent on the diagnosis provided .
  • To facilitate the detailed analysis of healthcare data for statistical and research purposes. (correct)
  • To standardize medical vocabulary across different specialties.
  • To train new medical staff.

What is the purpose of standardization in healthcare through coding systems?

  • To ensure any and all healthcare data is transferable and can be utilized for statistical analysis. (correct)
  • To allow international health agencies to accurately bill patients across different countries.
  • To allow healthcare facilities to easily use supplies from other countries during shortages.
  • To facilitate the sharing of patient medical records between providers.

In healthcare coding, what would be considered the most direct application of CPT codes?

<p>Classifying a surgical procedure performed in an outpatient clinic. (A)</p> Signup and view all the answers

Why is it essential for healthcare organizations to comply with coding systems as mandated by the federal government?

<p>Ensuring eligibility for reimbursement and recognition by healthcare agencies. (D)</p> Signup and view all the answers

What is the key distinction between ICD-10-CM and ICD-10-PCS?

<p>ICD-10-CM is used for coding diagnoses, while ICD-10-PCS is used for coding procedures. (C)</p> Signup and view all the answers

How does the use of ICD-10-CM in the United States differ from the broader, international application of ICD-10?

<p>ICD-10-CM is used to code disease information, much like ICD-9-CM, whereas international use of ICD-10 may vary. (A)</p> Signup and view all the answers

What is the purpose of the seventh character in ICD-10-CM coding?

<p>To provide detailed information about the encounter, such as whether it is an initial or subsequent visit. (D)</p> Signup and view all the answers

How does the structure of ICD-9-CM codes differ significantly from that of ICD-10-CM codes?

<p>ICD-9-CM codes consist of 3 to 5 characters, use only number and sometimes letters E and V and are structured without a 7th character and less specificity whereas ICD-10-CM consist of 3 to 7 characters, using number and letters, excluding U, and contain a seventh character. (A)</p> Signup and view all the answers

What does the 'S' choice usually define in relation to the 7th character when coding for outpatient therapies in ICD-10-CM?

<p>The encounter relates to a sequela, such as scar tissue, resulting from a previous injury. (C)</p> Signup and view all the answers

What is the primary advantage of transitioning from ICD-9-CM to ICD-10?

<p>Increased specificity, providing more detailed data for epidemiology and healthcare management. (C)</p> Signup and view all the answers

What is required to code an inpatient procedure at a hospital?

<p>ICD-10-PCS only (B)</p> Signup and view all the answers

Which of the following best describes the role of AHIMA in the context of ICD-10-PCS?

<p>Providing educational resources, such as flashcards, to assist in learning and applying ICD-10-PCS. (D)</p> Signup and view all the answers

Why are certain letters excluded from ICD-10-CM codes?

<p>To avoid confusion with numbers and improve readability. (D)</p> Signup and view all the answers

What is a key consideration when converting ICD-10-CM codes to ICD-9-CM codes?

<p>That such codes might not have an appropriate match as ICD-10-CM has higher specificity. (D)</p> Signup and view all the answers

Why is accurate clinical documentation important for efficient clinical data?

<p>All of the above. (D)</p> Signup and view all the answers

A patient has a chronic condition, which coding set would be the correct initial choice?

<p>ICD-10 (D)</p> Signup and view all the answers

Which of the following entities primarily uses ICD-10 codes for tracking public health?

<p>Goverment Agencies (A)</p> Signup and view all the answers

A coder is working on a patient that has a history of smoking, which coding action would improve the outcome in the scenario?

<p>Code the smoking status alongside the diagnosis to give a comprehensive overview. (B)</p> Signup and view all the answers

What impact do both CPT and ICD-10-CM code updates have on the hospitals?

<p>Updates ensure billing compliance so that reimbursement is not stopped. (A)</p> Signup and view all the answers

Clinical coding involves translating diseases, health-related issues, and procedural information exclusively into visual representations for data archiving.

<p>False (B)</p> Signup and view all the answers

One purpose of clinical coding is to hinder the retrieval of specific health information related to diseases for healthcare analysis.

<p>False (B)</p> Signup and view all the answers

According to the slide Healthcare Coding Systems, successful reimbursement does not depend on the use of coding systems recognised by the federal government.

<p>False (B)</p> Signup and view all the answers

According to the materials, Diagnosis/signs and symptoms, also known as 'Diseases' are exclusive to ICD11 and ICD12.

<p>False (B)</p> Signup and view all the answers

According to the slides, the International Statistical Classification of Diseases, Tenth Revision, was developed by the United Nations to collect health insurance information.

<p>False (B)</p> Signup and view all the answers

The material states that ICD-11-CM, much like ICD-8-CM, is used in the United States to code various forms of payment information.

<p>False (B)</p> Signup and view all the answers

In both ICD-9-CM and ICD-10-CM, the primary organization of codes is structured around a purely numerical sequence, disregarding alphabetical categorization.

<p>False (B)</p> Signup and view all the answers

The text says in ICD-10-CM, the number of codes is 140,000 codes.

<p>False (B)</p> Signup and view all the answers

In both ICD-9-CM and ICD-10-CM, special characters are not allowed in the strings.

<p>False (B)</p> Signup and view all the answers

In ICD-10-CM, the seventh String in a character does not hold any meaning.

<p>False (B)</p> Signup and view all the answers

Dysphagia has the same value in ICD-9-CM and ICD-10-CM, according to the presentation material.

<p>False (B)</p> Signup and view all the answers

In ICD-9-CM coding, the codes consist of 2 to 6 characters.

<p>False (B)</p> Signup and view all the answers

ICD-10-CM codes always start with a numeric character.

<p>False (B)</p> Signup and view all the answers

According to slide 'ICD-9-CM STRUCTURE—FORMAT', categories are always numeric.

<p>False (B)</p> Signup and view all the answers

Based on the information, 'ICD-10-CM STRUCTURE', extensions are never added to the code to explain external causes of injury.

<p>False (B)</p> Signup and view all the answers

For outpatient therapies, we will usually use one of 5 choices: the A, B, C, D and S.

<p>False (B)</p> Signup and view all the answers

According to the information given in the presentation, S = Initial encounter; tissue after burn.

<p>False (B)</p> Signup and view all the answers

The specificity of coding has decreased with ICD-10.

<p>False (B)</p> Signup and view all the answers

Based on the slides, increased use of combination codes, is not due to the increase of ICD-10 to 70 K codes.

<p>False (B)</p> Signup and view all the answers

For any in-patient procedures at a hospital, you are required to use code from ICD-9-PCS.

<p>False (B)</p> Signup and view all the answers

Match the following coding systems with their primary purpose:

<p>ICD-9 = Classification of diseases and some procedures prevalent before ICD-10 ICD-10 = Comprehensive classification of diseases and health-related conditions CPT = Coding outpatient procedures ICD-10-PCS = Coding inpatient procedures</p> Signup and view all the answers

Match the characteristic with the correct coding system

<p>ICD-9-CM = 3 to 5 characters, numeric second character. Used in the United States to code disease information. ICD-10-CM = 3 to 7 characters, alpha first character. The seventh character holds a different meaning. ICD-10-PCS = A multi-axial system designed for coding procedures in the United States CPT = Numeric codes with modifiers to describe medical, surgical, and diagnostic services.</p> Signup and view all the answers

Match the area with it's potential coding action:

<p>Diseases = Classified and coded for morbidity and mortality tracking Procedures = Coded to track interventions for billing and quality assessment Healthcare Statistics = Collected to support public health planning and research Inpatient Procedures at a hospital = The reason you will be required to used an ICD-10-PCS code</p> Signup and view all the answers

Match the medical data with the correct description:

<p>Clinical Data = Information about a patient’s signs, symptoms, diagnoses, and treatments Coding = The translation of diseases, health related problems and procedural concepts from text to Alphabetic/numeric Statistical Data = Aggregated data about diseases and procedures to identify trends and outcomes. Reimbursement Data = Information on how healthcare providers are paid for their services</p> Signup and view all the answers

Match the use case with it is potential goal:

<p>Enable retrieval of information on Diseases = Allows doctors to quickly access the required information related to a disease Collect statistics on the types of diseases and injuries = Allows the CDC to track diseases and injuries over time Planning healthcare facilities = Allows planners to understand changing capacity requirements Compare health status of countries = Allows the WHO to track how different countries fare against different health measures</p> Signup and view all the answers

Match the following term with a definition:

<p>ICD = International Statistical Classification of Diseases CM = Clinical Modification PCS = Procedure Coding System DRGs = Diagnosis Related Groups</p> Signup and view all the answers

Match each of the components listed with where they might be found:

<p>Alphabetic Index = ICD-9-CM and ICD-10-CM Numeric Code = ICD-9-CM and ICD-10-CM Modifiers = CPT Category, Etiology = ICD-9-CM Structure</p> Signup and view all the answers

Match common types of codes with what they do:

<p>International Codes = Allow for worldwide comparisons of morbiditiy Coding = Essential for proper health care reimbursement Diagnostic Coding = Allows efficient data retreival Speciality Specific Coding = More precise billing for complicated treatments</p> Signup and view all the answers

Match the type of code and whether it includes additional information:

<p>Injury = Character Extension is sometimes needed Diagnosis = Must be coded using ICD-10-CM Outpatient procedures = must be used as an additional extension to other codes Inpatient procedures = require an ICD-10-PCS code</p> Signup and view all the answers

Match the character with the code meaning:

<p>A = First Encounter Active Treatment D = After Active Treatment Routine S = Sequella, scar tissue after burn P = A code type is the first letter in 'pain'.</p> Signup and view all the answers

Match the code with its descriptor

<p>M24.551 = ICD10 code for contracture of right hip M24.552 = ICD10 code for contracture of left hip V54.13 = Aftercare for healing traumatic fracture of hip 572.0440 = Nondisplaced fracture of base of neck of right femur</p> Signup and view all the answers

Match the following disease to general symptoms:

<p>Dysphagia = Trouble Swallowing Oropharyngeal Dysphagia = Trouble Swallowing Initial Stage Nondisplaced Fraction = Complete fracture with the bones still aligned Arthritis = Limited Mobility</p> Signup and view all the answers

Match the code to its function:

<p>ICD = Track mortality rate CPT = Monitor outpatient procedures PCS = Track inpatient processes Diagnosis Coding = Allow efficient data retrieval</p> Signup and view all the answers

Match the system to its properties:

<p>CPT = Numeric format with modifiers Modifiers = Allow specific tracking for complicated treatments ICD-10 = Used for worldwide comparisons of mortality Diagnosis Coding = Allows efficient data retreival</p> Signup and view all the answers

Match the components listed to their descriptions:

<p>Etiology = Cause or origin of a disease Anatomic Site = specific location Alpha = Some codes use this Category = Group designation for medical condition</p> Signup and view all the answers

Match the situation to the care provider responsible for the codings:

<p>Inpatient Care = Uses facility coders to review documentation, and assigns the correct codes Physician Practice = Assigned by certified coders Outpatient care = Uses facility coders to review documentation, and assigns the correct codes Emergency Services = Assigned by certified coders</p> Signup and view all the answers

Match the problem with the code used to report it:

<p>Right Hip Contracutre = M24.551 Left Hip Contracture = M24.552 Healing Fracture = V54.13 Fractured Femar = 572.0440</p> Signup and view all the answers

Match the type of fracture with the code used to designate

<p>Impacted Fracture = Force driving one fragment into another Transverse Fracture = Breaks occurring at right angles to the long axis Oblique Fracture = Fractures occurring at a diagonal Avulsion Fracture = Tensile forces are applied rather than direct compression</p> Signup and view all the answers

Map the description to the acronym

<p>ICD = International Classification of Diseases CM = Clinical Modification PCS = Procedure Coding System DRG = Diagnosis Related Group</p> Signup and view all the answers

Map the reason for the statistic to the type of care provided:

<p>Mortality Rate = Allows tracking of mortality trends using Inpatient and Outpatient data Complications = Measured as a KPI relating to Physician performance Patient Care = Is linked to reimbursements which are tracked against Physicians Diagnosis Trends = Allows data analysis to project costs and facility requirements</p> Signup and view all the answers

Flashcards

Clinical Coding

Translating diseases and health-related problems into alphanumeric codes for data storage and analysis.

ICD (International Classification of Diseases)

A system used for coding diagnoses, signs, and symptoms of diseases.

ICD-PCS (Procedure Coding System)

A system used for coding medical, surgical, and diagnostic procedures.

ICD-10-PCS Use

Codes for inpatient procedures at hospitals.

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ICD-9-CM Structure

Alphabetic or numeric (first character); 3 to 5 characters; characters 2-5 are always numeric.

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ICD-10-CM Structure

Alphabetic (first character); 3 to 7 characters numeric or alphabetic numbers mixed.

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ICD-10

A statistical classification of diseases. It captures cause, site and severity of diseases.

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Learning objectives

Knowledge of what coding is, healthcare coding systems, DRGs and how it was developed.

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Why Clinical Coding?

To enable retrieval of information on diseases, collect statistics, plan healthcare facilities, and compare health status of countries.

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Healthcare Coding Systems

Diagnosis/signs/symptoms (ICD) and procedures (CPT).

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ICD-10-CM: Purpose

Used in the United States to code disease information, like ICD-9-CM.

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ICD-9-CM vs. ICD-10-CM

Dysphagia, oral phase in ICD9, is 787.21; in ICD10, R13.11.

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CPT Codes: When to Use

Outpatient procedures must be coded using CPT.

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ICD-10-CM Outpatient Choices

A = Initial encounter, D = After active treatment, S = Sequella.

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ICD-10 Specificity

The key behind is increased specificity.

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International Statistical Classification of Diseases

A coding system maintained by the World Health Organization for classifying diseases.

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Why is this Required?

Federal requirements dictate it is this system is needed to get properly reimbursed..

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ICD-9-CM Code A

Category of code.

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ICD-9-CM Code B

Etiology, anatomical site, and manifestation.

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ICD-10-CM Code A

Category of code.

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ICD-10-CM Code B

Etiology, anatomical site, and/or severity, Extension

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ICD-10-CM Code C

Added code extensions (7th character) injuries, and external causes of injury

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ICD-10 Code Side of the body

Side of body embedded in actual ICD10 code. Depending on where it's used, Cause of an injury

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Reason for increased ICD-10 codes

An increase in combo codes helped. So did, updated medical naming methods.

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Study Notes

  • Clinical Documentation Improvement (CDI) presentation by Dr. Mohamed Azmi

Learning Objectives

  • Define coding
  • Recognise healthcare coding systems for diagnosis and procedures
  • Define the concept of DRGs and its development

What is Coding?

  • Clinical coding translates diseases, health problems, and procedural concepts from text into alphanumeric codes.
  • These codes are used for storage, retrieval, and analysis of healthcare data.

Why Coding?

  • Enables retrieval of information on diseases.
  • Facilitates the collection of statistics on disease types and injuries.
  • Aids in planning healthcare facilities.
  • Helps compare the health status of countries

Healthcare Coding Systems

  • Diagnosis/signs and symptoms (Diseases)
  • ICD9, ICD10
  • ICD9-CM, ICD10-CM
  • Procedures
  • CPT
  • ICD-10-PCS
  • The use of these systems is required by the federal government for reimbursement
  • These systems are recognised by entities nationally and internationally

ICD-10

  • International Statistical Classification of Diseases, Tenth Revision, developed by the World Health Organization for capturing disease data.
  • ICD-10-CM (like ICD-9-CM) is used in the United States to code disease information.
  • Procedure information is coded using the ICD-10-PCS.
  • Includes updates to the ICD-10-CM and PCS

Comparison of ICD-9-CM and ICD-10-CM coding schemes

  • ICD-9-CM consists of 14,000 codes with 3 to 5 characters, the first being alpha or numeric and characters 2-5 are numeric. An example code is 787.21 for Dysphagia, oral phase
  • ICD-10-CM consists of 70,000 codes with 3 to 7 characters, the first character is alpha, and the second is always numeric. Example code is R13.11.
  • Side of the body is embedded in the actual ICD-10 code, such as M24.551 for contracture of the right hip and M24.552 for contracture of the left hip.
  • In ICD10, a 7th character can be used, with the section where it's used determining its meaning, such as the Cause of Injury.
  • For outpatient therapies in ICD-10-CM, , 3 choices are commonly used to describe an encounter:
  • A=Initial encounter active treatment
  • D=After active treatment as routine care
  • S=Sequella; scar tissue after burn
  • The increase from ICD-10 to 70 K codes is due to:
  • Updated medical terminology with modern medicine and expansion of procedures
  • Increased use of combination codes such as code E11.311, Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema.
  • Increased specificity

ICD10-PCS

  • ICD-10-PCS is a medical classification system for procedural codes that track various health interventions carried out by medical professionals.
  • If an inpatient procedure is being coded, the ICD-10-PCS code is required.
  • Outpatient procedures are coded using CPT-4 coding.

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