The US is approaching a crossroads regarding the diagnostic coding system that is used in all patient records and information exchanges that support patient care, research, quality measurement, and payment.…
Although International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) took effect on Oct. 1, 2015, there still are many gaps in the understanding and use of the code set.…
The revision was long pending and will feed the country-level mortality and morbidity data requirements to progress towards achieving sustainable development goals (SDGs) and universal health coverage (UHC). ‘International Classification…
If big data in healthcare is the future for medicine, then ICD-10 is the way to get there. Over the past year, most of the news surrounding ICD-10 has been either bureaucratic or comical in nature.
Many of the complexities of medicine are distilled down to a vocabulary of diagnostic codes, called the International Classification of Diseases (ICD), which are used by doctors, insurers, and hospitals.…
Mark your calendars -- the Centers for Medicare and Medicaid Services (CMS) announced it will conduct front-end testing of ICD-10 billing code submission between Medicare Administrative Contractors (MACs) and providers.…
As of Oct. 1, 2013, claims submitted in the United States must use ICD-10 codes and insurers will reject claims with ICD-9 codes. So what happens if a claim for…
While many innovative technologies, policies and procedures for managing patient data will be on display at the 83rd AHIMA Convention & Exhibit in Salt Lake City, the most pressing topic will be International…
Name: _____________________________________________ Date: _______________
1. A CPT code has ___5_____ digits and an ICD-9-CM code has ___3-5____ digits.
2. Explain the difference between a CPT code and an ICD-9-CM code.
CPT (Current Procedural Terminology), standardized numeric system (5 digits without modifiers) is used to report WHAT medical services and procedures are done to the patient.
ICD9 (International Classification of Diseases – Ninth Edition) a Universal coding system is used to describe WHY a service was performed. Codes range from 3-5 digits.
3. What is the purpose of a modifier?
To identify in certain circumstances that a service or procedure has been altered by some specific circumstance but it has not changed the basic definition or code (this is the literal CPT book definition, but anything remotely close to this is acceptable).
4. What are E&M codes?
Evaluation and Management Codes that describe different levels of physician “visits” in various healthcare settings.
5. What does “COB” stand for? Coordination of Benefits
6. What insurance information do you obtain when the patient contacts our office with new insurance?
Guarantor name, guarantor DOB, guarantor policy and group number, new insurance name, address for claims submission, effective date of new policy, and (if possible) termination date of previous policy.
7. If the patient has Medicare and Medicaid, which insurance would you bill first?
Medicare would always be billed first.
8. What does HIPAA stand for? And what does it mean to you? Health Insurance Portability and Accountability Act.
HIPAA designates certain standards and procedures that must be followed to keep secure PHI (protected Health Information). HIPAA also calls for standardization of transaction code sets and various privacy laws (looking for some level of knowledge about the general concept of HIPAA).
9. How would you handle each of the following EOB rejections?...
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