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Medical Coding | Medical Billing Coding Transcription: Certification Training Course id="page-container">

Computer Assisted-Coding – ICD-10

Technological breakthroughs have led to advances in diagnosis and treatments.  And technology is an asset to the business side of healthcare too. Software makes it more efficient to manage clinical information and run the business of medicine. So it’s curious that one of the problems identified during the ICD-10 National Pilot Program is that medical coders relied too much on computer-assisted coding (CAC) applications. CAC was supposed to make medical coding easier and boost medical coding productivity. If a healthcare provider has already started using a CAC system, it can raise productivity to a level that compensates for the drop caused by ICD-10 implementation. CAC can do a lot for healthcare providers: Increase medical coding productivity and efficiency Increase medical coding consistency Create a medical coding audit trail Create data queries Allow more comprehensive medical code assignment Improve medical coding accuracy Decrease medical coding costs Use free text for recording documentation Improve systems through feedback But the National Pilot program suggests that CAC doesn’t do so much for medical coding accuracy and productivity. CAC can be an asset in the ICD-10 transition if: Templates and interfaces are built to do the job properly. Electronic health records (EHR) templates are customized to maximize clinical documentation improvement (CDI) initiative. The National Pilot Program probably was infected by GIGO (Garbage in. Garbage out.) Paul Weygandt (Nuance Services) noted the problem with using CAC systems in ICD-10 implementation strategies. “Those systems don’t work when physicians don’t enter the correct information to generate ICD-10 codes. There are some structurally obvious coding queries which could be generated by computer assisted coding,” he wrote. “But the...

What is Medical Coding?

What is Medical Coding? History and Pertinent Facts Coding was devised to help standardize billing to insurance companies as well as to provide more information about diagnoses, treatments and the epidemiology of disease. CPT codes:  The Relative Value System (RVS) was designed by insurance companies.  It was used for many years, and then evolved into the Current Procedural Terminology (CPT) and was copyrighted by the AMA. The CPT tells what the physician did to correct the problem.  ICD Codes:  The International Classification of Diseases (ICD in various versions, currently the 9th revision) reports various diseases.  The ICD tells what is wrong with a patient and shows medical necessity. HCPC Codes:  A third system was developed by HCFA (Healthcare Financing Administration)  in 1982 for Medicare and Medicaid billing.  They contain CPT, National, and Local codes.  CPT codes are considered to be the level 1 codes of HCPCS.  National codes are the Level 2 codes of HCPCS.  Local codes are level 3 codes of HCPCS.  Used for billing procedures and services that include dental work, durable medical equipment, injections, ophthalmologic services, orthotics, some laboratory and pathology, and vision care. APC Codes (Ambulatory Patient Care) are used by hospital outpatient departments. So What Do Coders Do? They look up various diseases and treatments using an alphabetic system which points them to specific detail relating to patient problems and the medical care to fix the problem.  They use CPT, ICD, and if working in a hospital or large clinic, they use APC codes to cover items not in the CPT and ICD code systems. E-Codes:  If the patient is involved in an injury of...

ICD-10 Code FAQs

ICD-10 Code FAQs Transition Basics ICD-9 and ICD-10 Health and Human Services Secretary Kathleen Sebelius announced the release of a rule that makes final a one-year proposed delay—from October 1, 2013, to October 1, 2014—in the compliance date for the industry’s transition to ICD-10 codes. Secretary Sebelius first announced the proposed delay in April (2012)   as part of President Obama’s commitment to reducing regulatory burden. With any luck, this will be the last delay since there have been so many.  Here is the announcement, written in stone (so to speak). The deadline for the transition to ICD-10 is October 1, 2014. Um, well, powerful lobbies worked on Congress to delay it another year, sigh…so it’s now 2015. So what does it all mean? 1. What does ICD-10 compliance mean? ICD-10 compliance means that everyone covered by HIPAA is able to successfully conduct health care transactions using ICD-10 codes.  2. Will ICD-10 replace Current Procedural Terminology (CPT) procedure coding? No. The switch to ICD-10 does not affect CPT coding for outpatient procedures. Like ICD-9 procedure codes, ICD-10- PCS codes are for hospital inpatient procedures only.  3. Who is affected by the transition to ICD-10? If I don’t deal with Medicare claims, will I have to transition? Everyone covered by HIPAA must transition to ICD-10. This includes providers and payers who do not deal with Medicare claims.  4. Do state Medicaid programs need to transition to ICD-10? Yes. Like everyone else covered by HIPAA, state Medicaid programs must comply with ICD-10.  5. What happens if I don’t switch to ICD-10? Claims for all services and hospital inpatient procedures performed on or...

ICD-10 Coding Training Scheduled To Arrive

Officials at the Centers for Medicare and Medicaid Services (CMS) declared that Oct. 1, 2014 would be the firm implementation date for ICD-10, the newest iteration of the International Classification of Diseases (ICD) coding system used on medical claim forms. The question then became how to handle the transition from ICD-9 to ICD-10, especially as it relates to updating each set of codes during the transition. CMS officials proposed a “limited freeze,” under which the last regular, annual updates to both ICD-9 and ICD-10 would be made on October 1, 2011. A year later, 2012, limited changes would be made to both sets of codes to account for new technologies and diseases. The next year, on October 1, 2013, limited changes would again be made — but only to the ICD-10 codes, as ICD-9 would be phased out. One year later, on October 1, 2014, the regular annual update to ICD-10 would begin. Congress (coincident to another bill) delayed full implementation to October 1, 2015. In September, the ICD-9-CM Coordination & Maintenance Committee announced that the “limited freeze” proposal had been accepted, paving the way for the transition from ICD-9 to ICD-10 to begin in earnest. Although ICD-10 codes differ from ICD-9 in several ways — such as the number of characters used in each code and the use of an “x” placeholder — the biggest difference between the two coding sets is the number of codes involved. Because they are more complex and detailed, ICD-10 includes 69,099 diagnosis codes compared with only 14,315 ICD-9 codes. So far, providers’ progress on switching over to the new codes has been...

Coder Shortage

As healthcare providers and facilities look to fill coding positions, recruiters and human resource directors are doing their best to lure prospects into the fold. Medical coders essentially provide the framework for all medical reimbursement responsibilities; without them, providers wouldn’t get paid. The sheer number and detail involved in reporting medical procedures, and the ever-increasing demand for data collection and analysis (both from government and private agencies), compliance issues, and variations in coding courses have spurred an increased demand for medical coding professionals. The problem is that finding qualified individuals to fill basic coding positions has become increasingly difficult. Healthcare facilities from across the nation have felt the pinch and are finding creative ways to ensure that their needs will be met. The ability to work from home and the use of flexible scheduling, along with offering more competitive pay and a low-stress work environment, are among the most effective recruiting strategies that healthcare providers are using to recruit coders. Telecommuting A good example of addressing the reality of establishing a home coding system that works is a news story about a hospital in the southwest that has 900 beds, 30,000 inpatients and 220,000 outpatient visits each year. Twelve fulltime coders, five part-time and two quality reviewers were traditionally employed, with plans to expand adding additional coders. Since the hospital is located in a major metropolitan area, many people did not want to drive to the downtown area. The hospital was using an EMR (electronic medical record) system, allowing access to it remotely. The administration ultimately approved setting up a couple of coders at home. It worked. Municipal planners...

Medical Coding Specialist

The health care industry continues to represent the fastest growing segment of our nation’s economy. Increasing numbers of trained career-oriented professionals enter this promising field each year, sharing common goals, interests and needs. To help providers and employees meet their goals we offer certification and continuing education services. If you are considering becoming a Medical Coding Specialist, we have the resources for you. Certified Medical Assistant (CMA & CMAA) Certified Coding Associate (CCA) Certified Medical Transcriptionist (MTC & MTCX) Looking to be a Medical Billing Specialist instead? We also offer Legal...