Intro to Coding

ICD-10-CM/PCS

- replaces ICD-9-CM, Volumes 1, 2, and 3, including the Official Guidelines for Coding and Reporting

ICD-10-CM and ICD-10-PCS

-ICD-10-CM will be used for reporting of diseases and condition in all health care settings in the US effective October 1, 2013 Postponed

ICD-9-CM Official Guidelines for Coding and Reporting

-Required component of the ICD-9-CM code set in the final rule for electronic transactions and coding standards -Adherence to the ICD-9-CM guidelines are a requirement for compliance with the HIPAA rule

Medicare Prescription Drug, Improvement and Modernization Act of 2003

-Signed into law December 8, 2003 Section 503 of the Act includes the possibility that code changes could occur two times a year: April 1 and October 1 -However, ICD-9-CM codes have only been updated on October 1st of each year since this law took effect

CPT/HCPCS and ICD-9-CM Volume 3

-The CPT/HCPCS codes are used for physicians and other healthcare services, such as hospital outpatient services - ICD-9-CM Volume 3 procedure codes are restricted to the reporting of inpatient procedures by hospitals

ICD-9-CM c

-The US Public Health Service modified ICD-9 to meet the needs of American hospitals and called it the International Classification of Diseases, Ninth Edition, Clinical Modifications (ICD-9-CM) -9th revision expanded to 3 volumes and introduced a fifth-digit subclassification

ICD-10-CM

-disease classification -More specific and contains significantly more codes than ICD-9-CM Codes are alpha-numeric with all letters except U -Codes can extend up to 7 characters -2012 version of ICD-10-CM will be the last full update version before the implementation date of October 1, 2013

ICD-9-CM b

1948 - The World Health Organization (WHO) in Geneva Switzerland assumed responsibility for revising ICD every 10 years

ICD-9-CM a

APHA recommended the system be revised every ten years to remain current with medical practice

A Point to Remember

All ICD-9-CM coding books must be updated yearly with the ICD-9-CM revisions All coding software (encoders) must be updated yearly As a general rule, new ICD-9-CM codes are effective October 1 of each year

HIPAA Electronic Transactions and Coding Standards Rule a

August 17, 2000 - Department of Health and Human Services published the final regulations for electronic transactions and coding standards Designated five medical code standards to be used initially under the HIPAA rule

What is Coding

Coding is the transformation of verbal descriptions into numbers Specific codes describe diseases, injuries and procedures

ICD-9-CM Coordination and Maintenance Committee

Composed of representatives from NCHS and CMS Responsible for maintaining the United States clinical modification version of the ICD-9-CM code sets. Two open meetings each year - public forum for discussing proposed revisions to ICD-9-CM Meeting announcement, proposals and minutes can be found on NCHS and CMS websites

The 2009 Final Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification with Modifications to the medical data code sets

Established standard that ICD-10-CM would be used for diagnosis coding Established standard that ICD-10-PCS would be used for the inpatient hospital procedure coding

HIPAA Electronic Transactions and Coding Standards rule b

Five medical code sets ICD-9-CM, Volumes 1, 2 and 3 CPT Healthcare Common Procedure Coding System (HCPCS) Code on Dental Procedures and Nomenclatures, 2nd Edition (CDT-2) National Drug Codes (NDC)

ICD-9-CM classification system

Maintained by National Center for Health Statistics and Centers for Medicare and Medicaid Services

HIPAA Electronic Transactions and Coding Standards rule c

National Drug Codes - standard medical data code set for reporting drugs and biologics for retail pharmacy claims Hospitals and physicians likely to use HCPCS to report drugs and biologics

Official Addendum to ICD-9-CM

The Official Authorized Addendum contains the codes that were added, revised or deleted in ICD-9-CM effective April 1st or October 1st each year National Center for Health Statistics (NCHS) is responsible for maintaining the diagnosis classification (Vol 1 and 2) Centers for Medicare and Medicaid Services (CMS) is responsible for maintaining the procedure classification (Vol 3) NCHS and CMS publish the addenda with the approval of WHO

ICD-9-CM b

Volume 3, procedures, has been limited to procedures or other actions taken for diseases, injuries and impairments of hospital inpatients reported by hospitals Non-acute facilities do not use Volume 3 to report procedures. Instead these sites use HCPCS Level I (CPT) and HCPCS Level II codes as appropriate

ICD-9-CM

Volumes 1 and 2, cover diseases, injuries, impairments and other health problems and their manifestations, as well as cause of injury and disease impairment

ICD-10-PCS

was developed by 3M Health Information Systems under contract with the Centers for Medicare and Medicaid Services (CMS).