Friday, October 7, 2016

FAQ: Medical Codes

FAQ: Medical Codes



Question: Where can I find medical codes, such as the ICD, CPT, or HCUP?

Answer:


You can find medical codes in the:

CDT: Code on Dental Procedures and Nomenclature by the American Dental Association
The CDT is the official coding used by dentists.
Classification of Death and Injury Resulting from Terrorism by the National Center for Health Statistics (NCHS), U.S. Centers for Disease Control & Prevention
These codes identify deaths from terrorism as reported on death certificates. Health care providers use the Classification to report terrorism-related injuries and illnesses on medical records for statistics and reimbursement.
CPT®: Current Procedural Terminology by the American Medical Association
CPT codes describe services performed by health care providers. CPT Codes Mapped to CVX (Vaccines Administered) Codes are also available.
DRGs: Diagnosis-Related Groups by the U.S. Centers for Medicare & Medicaid
DRGs group patients by diagnosis, type of treatment, age and other factors. Hospitals are paid a set fee for treating patients in a single DRG category.
DSM: Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association
Psychiatrists and other mental health providers use the DSM-5 criteria for diagnosing psychiatric diseases.
HCPCS: Healthcare Common Procedure Coding System by the U.S. Centers for Medicare & Medicaid
The HCPCS is divided into two levels. Level I is the CPT: Current Procedural Terminology. Level II identifies products, supplies and services not in Level I, such as ambulance services.
HL7: Health Level Seven by Health Level Seven International
HL7 provides clinical and administrative data standards to allow healthcare computer systems to communicate with each other, using like concepts bound to codes.
HCUPNet: Healthcare Cost and Utilization Project by the U.S. Agency for Healthcare Research and Quality
HCUPNet has health statistics and information on hospital inpatient and emergency department visits, searchable by ICD-9-CM or DRG codes.
ICD: International Classification of Diseases, by the U.S. Centers for Disease Control & Prevention and the World Health Organization
The ICD is used to classify diseases on many types of records, including death certificates and hospital records. All versions of ICD-9 and ICD-10 are at the CDC Web site. An online version of the ICD-10 is also available from the World Health Organization.
ICF: International Classification of Functioning, Disability and Health by the published by the U.S. Centers for Disease Control & Prevention and the World Health Organization
The ICF classifies the consequences of disease. A searchable version of the ICF is available.
LOINC provides formal names and standardized codes for laboratory and other clinical observations.
Newborn Screening Coding and Terminology Guide by the U.S. National Library of Medicine®
This code promotes the use of electronic health data standards to record and transmit newborn screening test results.
RxNorm by the U.S. National Library of Medicine
RxNorm provides standard names for clinical drugs. RxNorm also links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software.
SNOMED CT®: Systematized Nomenclature of Medicine-Clinical Terms by IHTSDO: International Health Terminology Standards Development Organisation (originally developed by the College of American Pathologists)
SNOMED CT is a comprehensive clinical terminology. A subset, SNOMED CT Core Subset, is also available. The Core Subset is useful for documentation and coding of clinical information at a summary level.
IHTSDO also provides a list of free service online SNOMED CT® Browsers including the National Library of Medicine's SNOMED CT® Browser.
UMLS®:Unified Medical Language System® by the U.S. National Library of Medicine
The UMLS links different names and views of the same concept and identifies relationships between them. The UMLS Metathesaurus has more than 150 terminologies, vocabularies, and code sets, including SNOMED CT, LOINC, MeSH®, and RxNorm.
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https://www.nlm.nih.gov/services/medcodes.html
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2016 Medical Coding Books

Medical Billing and Coding For Dummies 2nd Edition

Your complete guide to a career in medical billing and coding, updated with the latest changes in the ICD-10 and PPS
This fully updated second edition of Medical Billing & Coding For Dummies provides readers with a complete overview of what to expect and how to succeed in a career in medical billing and coding. With healthcare providers moving more rapidly to electronic record systems, data accuracy and efficient data processing is more important than ever. Medical Billing & Coding For Dummies gives you everything you need to know to get started in medical billing and coding.
This updated resource includes details on the most current industry changes in ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems) and PPS (Prospective Payment Systems), expanded coverage on the differences between EHRs and MHRs, the latest certification requirements and standard industry practices, and updated tips and advice for dealing with government agencies and insurance companies.
  • Prepare for a successful career in medical billing and coding
  • Get the latest updates on changes in the ICD-10 and PPS
  • Understand how the industry is changing and learn how to stay ahead of the curve
  • Learn about flexible employment options in this rapidly growing industry
Medical Billing & Coding For Dummies, 2nd Edition provides aspiring professionals with detailed information and advice on what to expect in a billing and coding career, ways to find a training program, certification options, and ways to stay competitive in the field.




CPC Practice Exam 2016: Includes 150 practice questions, answers with full rationale, exam study guide and the official proctor-to-examinee instructions 5th Edition

by Gunnar Bengtsson  (Author), Kristy L Rodecker (Author)
150 question CPC practice exam designed to mirror the actual AAPC CPC exam.
This practice exam has the same basic structure and category divisions with questions very similar to those found on the real exam. The answer to each question also includes a detailed rationale.
Updated for 2016
Will definitely help you pass the CPC exam issued by the AAPC, and is also helpful if you are taking the CCS exam by AHIMA. Don't let your dream of becoming a Certified Professional Coder pass you by! The medical billing and coding exam is not easy to pass, and this book will help you feel less intimidated when taking the test - you will feel like you've already taken it.
Questions Subject
  • 1-10 Medical Terminology
  • 11-20 Anatomy
  • 21-30 Coding Concepts
  • 31-40 ICD-10-CM
  • 41-45 HCPCS
  • 46-51 E/M 99201-99499
  • 52-61 Anesthesia 00100-01999
  • 62-71 Integumentary 10021-19499
  • 72-80 Musculoskeletal 20005-29999
  • 81-90 Respiratory, Cardiovascular, Hemic and Lymphatic, Mediastinum and Diaphragm 30000-39599
  • 91-100 Digestive 40490-49999
  • 101-110 Urinary, Male and Female Genital Systems, Maternity Care and Delivery 50010-59899
  • 111-120 Endocrine, Nervous, Ocular and Auditory Systems 60000-69990
  • 121-130 Radiology 70010-79999
  • 131-140 Pathology and Laboratory 80047-89398
  • 141-150 Medicine 90281-99607




CPT 2016 Professional Edition (Current Procedural Terminology, Professional Ed. (Spiral)) (Current Procedural Terminology (CPT) Professional) 2016th Edition

CPT® 2016 Professional Edition is the definitive AMA authored resource to help health care professionals correctly report and bill medical procedures and services. The AMA publishes the only CPT® codebook with the official CPT guidelines.



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ICD-10 Myths

ICD-10 Myths

Debunking Myths and Misperceptions of ICD-10 

In today's social, shareable society, myths spread faster than ever. Fortunately, old-fashioned facts still trump inaccurate and misleading information.
The August issue of the Journal of AHIMA uses evidence to dispel three of the most persistent ICD-10 falsehoods in "Myths of ICD-10-CM/PCS." The article is authored by Sue Bowman, MJ, RHIA, CCS, FAHIMA, American Health Information Management Association (AHIMA) senior director, coding policy and compliance. She is AHIMA's representative to the Cooperating Parties, a group with direct input into the creation, maintenance, and updating of healthcare codes and guidelines for their use.
The three misperceptions addressed in the article are the idea that replacement of ICD-9-CM is not a necessity; the increase in the number of codes from ICD-9 to ICD-10 increases the difficulty of using the new code set; and that SNOMED CT or ICD-11 represent viable alternatives to ICD-10-CM/PCS implementation.
"The transition to ICD-10 continues to be inevitable and time sensitive," said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. "As the healthcare industry experiences an additional delay in ICD-10 implementation, now is the ideal time to rebut ICD-10 myths that continue to percolate.
MYTH 1: ICD-9-CM is not a necessity
Replacing the "obsolete" ICD-9-CM is not optional. Bowman writes, "... Its limited structural design lacks the flexibility to keep pace with changes in medical practice and technology. The longer ICD-9-CM is in use, the more the quality of healthcare data will decline, leading to faulty decisions based on inaccurate or imprecise data."
In addition, if data on new diseases and technology or distinctions in diagnoses and procedures can't be captured, there is no basis to effectively analyze healthcare costs or outcomes. Without ICD-10, the value of investment in electronic health records (EHR) is significantly diminished, as the more comprehensive and detailed information will be lost when aggregated into the outdated and ambiguous codes in ICD-9-CM.
MYTH 2: Increasing the number of codes from ICD-9 to ICD-10 increases the difficulty of using the new code set.
While considerable attention is paid to the larger number of codes in the new code set, the major reason for the expansion is simple: 46 percent of the added codes reflect the ability to identify the affected side of the body.
More comprehensive and precise codes will actually make it easier to find the right code, just like it's easier to find the correct word in a comprehensive dictionary. Bowman writes, "&Increase in specificity, clinical accuracy and a logical structure facilitate - rather than complicate - the use of a code set." Also, much of the extra detail was requested by practitioners because the greater specificity provided value that was thought to be clinically significant.
MYTH 3: SNOMED CT or ICD-11 represent viable alternatives to ICD-10-CM/PCS implementation
Clinical terminology systems such as SNOMED CT and classification systems such as ICD-10 play separate but equally important roles in healthcare delivery. They are complementary not exclusive of each other.
For example, Bowman writes, "...Health records created and stored in electronic environments require the use of uniform health information standards, including a common medical language. Together terminologies and classification systems provide the common medical language necessary for interoperability and the effective sharing of clinical data. ... SNOMED CT and ICD-10-CM/PCS used together in EHR systems can contribute to patient safety and evidence-based high-quality care provided at lower cost by leveraging a capture once, use many times' process."
Although the World Health Organization (WHO) estimates ICD-11 will be finalized and released in 2017, that date marks the beginning, not the end of the process toward adoption. For example, ICD-10 was endorsed by the 43rd World Health Assembly in 1990 and WHO member states began using it in 1994. It took eight years to develop a U.S. modification of ICD-10 and a procedure coding system and 19 years for a final rule to be published. Five years following the publication of the rule, ICD-10-CM/PCS has still not been implemented.
The process for evaluating ICD-11 for use in the U.S and developing the necessary modification to meet our country's specific information needs and developing a procedure coding system would take at least a decade; then, there would be the rulemaking process to adopt ICD-11 as a HIPAA code set standard.
" In a 2013 report, the American Medical Association Board of Trustees recommended against skipping ICD-10 and moving directly to ICD-11 for a number of reasons, including: "ICD-9 is outdated today and continuing to use the outdated codes limits the ability to use diagnosis codes to advance the understanding of diseases and treatments, identify quality care, drive better treatments for populations of patients, and develop new payment delivery models."
About AHIMA
The American Health Information Management Association (AHIMA) represents more than 71,000 educated health information management and health informatics professionals in the United States and around the world. AHIMA is committed to promoting and advocating for high quality research, best practices and effective standards in health information and to actively contributing to the development and advancement of health information professionals worldwide. AHIMA's enduring goal is quality healthcare through quality information.www.ahima.org
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Top 10 Most Hilarious Codes in ICD-10

Top 10 Most Hilarious Codes in ICD-10

The official U.S. launch of ICD-10 has come and gone. Some folks were happy to see this finally happen, while others were pretty angry that it was not further delayed. Love it or hate it, I think there is one thing everyone can agree on -- among the 68,000+ billing codes in ICD-10, there are some pretty weird (and hilarious) things to be found.
In this article, we’re going to have a bit of fun by looking at what I consider to be the top ten oddest and most hilarious billing codes in ICD-10.
10. Y93.84 – Injured while sleeping
I don’t know what some people are doing in their sleep, but whatever it is must be dangerous if it results in injury. Seriously… where are people sleeping?  On cliffs? In reality, I imagine most uses of this code probably involve accidents with bunk beds. However, it’s still pretty funny.
9. Y92.253 – Injured at an Opera House
This code was either included for work-related accidents for opera house stage crews… or somebody on the ICD-10 development team had been to see Phantom of the Opera way too many times.
8. W22.02 – Walked into lamppost
To be perfectly honest, I don’t find this one all that unusual (or even surprising). Just look around these days and you will see scores of people who walk while texting, paying no attention to what’s in front of them. Is it really that hard to believe collisions with various objects will occur?  I would imagine that smacking one’s face into a lamppost is but one of the many perils of distracted walking.
7. W61.43 – Pecked by a Chicken:
Why did the turkey cross the road? Apparently, so he could avenge the deaths of his fallen Thanksgiving kin by unleashing some sharp-beaked justice on humankind. (Oh, were you expecting that joke to be about a chicken? Believe it or not, there’s a code for that as well—W61.33





6. Z63.1 – Problems in relationship with in-laws
Y’know… For those times when your patients’ relationships with their in-laws become so problematic they actually have to seek out medical attention.
5. Y92.241 – Injury at library
My imagination ran absolutely amuck with this one. For what could this code possibly be intended? Just in case the local book club suddenly goes off the rails? Or perhaps for when the normally mild mannered librarian finally goes ballistic on someone for having too many unpaid overdue fees? Of course, in any environment there’s always going to be that one guywho finds a way.
4. V97.33 – Sucked into jet engine
I would definitely count being sucked into a jet engine among the top five least pleasant things to experience. Luckily, this can be easily avoided by never walking in front of a jet engine. Believe it or not, there are people who have actually survived being sucked into a jet engine and spit out the other side (though I would imagine it’s a pretty short list). Just in case someone is unlucky (or unobservant) enough to have it happen again, there’s also a code for subsequent encounters (V97.33XD).
3. X52 – Prolonged stay in a weightless environment
This code would be weird enough by itself. However, its oddness is further compounded by the fact that X51-X58 are categorized under “accidental exposure.” How, pray tell, would someone accidentally end up having a prolonged stay in a zero gravity environment? Did somebody accidentally board the wrong spacecraft, forcing them to endure an involuntary 6 month stint at the international space station?
The code also specifies “Weightlessness in spacecraft (or simulator),” which just makes it all the weirder. I’m pretty sure that if someone gets into a spacecraft or simulator for any length of time, that he/she would have done so on purpose. This left me to ponder what situation might cause a person to be accidentally/involuntarily exposed to a prolonged stay in a zero gravity environment, and I could only come to one conclusion -- alien abduction.
So I guess the good news is that, if you’re ever abducted by aliens and forced to endure a prolonged state of weightlessness, your primary care physician will be able to properly code it when the extraterrestrials are finally done experimenting on you.

2. V95.43 – Spacecraft collision injuring occupant
And if by some odd happenstance the spaceship of your alien abductors collides with adifferent spacecraft, causing you to be injured, ICD-10 still has you covered. 
(Then again, maybe they just figure most people will be able to fly around in spaceshipssomeday?)
1. V91.07 – Burn due to water skis on fire
Water skis… on fire. This code has left me with so many questions (not to mention some pretty insane mental images). The most obvious question is how, exactly, would water skis (assumedly while being worn/used) even catch on fire? Was someone doing a stunt that involved water skiing over fire? Or maybe someone experienced a catastrophic failure while testing an experimental pair of rocket powered water skis? I mean, I just cannot think of a scenario in which water skis would (or even could) accidentally catch on fire.
And there you have it, folks… the top ten most hilarious ICD-10 codes.
ICD-10… it’s here… it’s weird… get used to it.
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