Coding and Billing Procedures Chapter 14

Establishment of Codes

• In 1946, the International Commission of the World Health Organization (WHO) established codes for infectious diseases, parasites, symptoms, and causes of death.
• This led to the creation of the International Statistical Classification of Diseases (ICD) for use by insurers, health administrators, hospitals, and military medical providers.

Transition from ICD-9 to ICD-10

• ICD-9-CM, introduced in 1975, utilized a code format of 3-character categories, 4-character subcategories, and 5-character subdivisions.
• ICD-10-CM, approved in 1995, introduced a more complex format with up to 7 characters and a period after the 3rd character.

Coding Requirements

• Healthcare providers must use approved medical codes for procedures and services to obtain reimbursement.
• Diagnoses are assigned through the assessment of the patient.

Details of ICD-10-CM

• The ICD-10-CM code set assigns a code for diseases or injuries treated, made up of up to 7 characters.
• Diagnostic statements are sourced from operative reports, discharge summaries, and ancillary diagnostic service reports.

Entities Recognizing Codes

• Key entities such as practice management software, clearinghouses, and third-party payers facilitate coding processes and assist in speeding up reimbursement for healthcare providers.

Volume Structure of ICD-9-CM

• The ICD-9-CM code set is organized into three volumes:
  • Volume 1: Tabular List of Diseases and Injuries.
  • Volume 2: Alphabetic Index to Diseases and Injuries.
  • Volume 3: Coding guide for inpatient procedures and services in hospitals.

General Equivalence Mappings (GEMs)

• GEMs serve as translation references between ICD-9-CM and ICD-10-CM, providing practical code-to-code mappings.
• A complete list of GEMs is available on the CMS website to assist with ICD-10-CM coding.

Key Terminology

• Abstract: Summary of diagnostic statements and procedures/services performed.
• Acute: Initial assessment and treatment of a condition.
• Chronic: Long-term disease due to unresolved medical treatment.
• Coding Clinic: An industry journal providing insights into complex medical coding cases.
• Diagnostic Statement: Extracted information from medical documentation related to a patient's diagnosis.
• Encounter: Documented interactions between a patient and healthcare provider.
• Etiology: The cause of a disorder, critical for claim classification.
• Histologic: Refers to the microscopic composition of tissue.
• Impending: Describes a condition that threatens imminent health, e.g., prediabetes.
• Manifestation: Indication of an illness or condition.
• Neoplasm: Abnormal tumor growth with specific ICD-10-CM diagnostic codes based on six classification criteria.
• Notations: Instructions or guides for coding classifications found in both indexes.
• Reimbursement: Claim submission process to insurance for payment of services rendered, using codes instead of textual descriptions.

This quiz focuses on Chapter 14 of the Coding and Billing Procedures, providing flashcards that cover key concepts like the origins of coding systems and their purposes. Learn about the establishment of infectious disease codes by WHO in 1946 and the creation of ICD. Test your knowledge with these essential terms and definitions!