Medical coding Presentation B.Pharmacy 8th Semester 2020 (2019-2020) Previous Year's Question Papers/Notes Download - HK Technical PGIMS

What You’ll Learn
Basic Knowledge on types of health
record documentations and key points
need to identify in a medical record
04
Identify the tools available for Medical Coding 05
Obtain Knowledge on how to enroll for certification 06
Basic understanding of the
structure of a Medical Code
and its use
.
01
Medical coding syllabus, Coding types,
Updates & Specialties in coding 02
Gain Knowledge on how to pick a
code from Coding books and software
tools
03
What is Medical Coding
Benefits of Medical coding
• Statistical analysis of diseases and treatments
(Morbidity data & Mortality data)
• Diagnosis related group reimbursement
• Easy tracking of Pandemic events
• Easy storage and access of data at any time
when required
• Patient can get treatment any hospital
• Coding can decrease the fraud (No extra
charges for treatment)
Medical Coding is the process of conversion of
medical records into numerical data. especially the
Diagnosis, procedures into universally accepted
codes.
Medical coding is one of the processes in the USA
Healthcare industry where many companies in
India getting projects outsourced from the United
States.
Currently we are in
ICD 10 CM
implemented in 2015
The list was expanded further and renamed as the
International Classification of Diseases (ICD). In 1977, ICD
codes were developed further to include clinical diagnoses
such as illnesses and injuries, not just causes of death. By
expanding the codes to include more diagnosis
classifications, medical records became more
comprehensive, and this gave doctors the opportunity to
provide extensive and overall better health care
1830’s when Dr. William Farr,
a British Epidemiologist, went
before the newly formed
International Statistical
Congress and proposed a
uniform classification system.
By the 1930’s this system
evolved into the International
List of Causes of Death.
The official coding of diseases began
around the 17th century in England.
Known as the London Bills of Mortality,
certain data of diseases and ailments
were collected and arranged into
numerical codes. The numerical codes
were then used to measure the most
frequent causes of death.
History of Medical Coding
Revenue Cycle Management
o All the individuals who resides in
other countries they will be enrolled
for insurance hence doctors may not
receive direct payment from patient
o Once patient visits to the hospital he
will get treated by doctor and entire
scanned documents or voice file will
be changed to text format by a
Medical Transcriptions then the file
moves to a Medical Coder once the
coding completed it will be taken to
Medical Biller, they will cross verify
the insurance and submit the claim
o Once claim got settled payment will
be issued to doctor or a Hospital
Patient Registration
Eligibility Check
Doctor Treat Patient
Scanning
Claim submission
Medical Coding Demographics Entry Posting
AR Follow – up
Reimbursement to Provider
Denial Management
Charge Entry
Future & Career Growth in Medical Coding
❑ Career growth is too good starting from Coding Executive level to Senior Coder, Group Co-coordinator, Team Leader, Trainer,
Assistant Manager, Manager and Director Positions are given based on performance.
❑ After completion of any of the AAPC approved certificates, coder’s salary, as well as position, will be improved and lot of Abroad
opportunities for a Certified Coder as well as they can start small business when they try to get a client.
20% 30% 50% 75% 100%
What is Required to become a Coder
❑ To work as a medical coder, need to have Knowledge on Human
anatomy, medical terminology and medical abbreviations.
Eligibility for Medical Coding
Physiotherapist
Nursing
B. Pharmacy
M. Pharmacy
Bio-chemistry
Biotechnology
Micro-biology
Botany
Zoology
Nutrition
Dietician
Ayurvedic Medicine
Homeopathic Medicine
Medical transcriptionist
Bachelor of Dental science
B.SC
M.SC
Any Degree or Diploma in
life sciences
Specialties in Medical Coding
1. As a certified coder you start
working with different Specialty
2. Ancillary Projects
(Laboratory, Pathology,
Radiology coding)
8. Anesthesia coding, IVR, Home health coding
Denials Coding and Ambulance Coding
7. Wound care &
Oncology coding
6. IP-DRG coding
5. Ambulatory surgery
(SDS, Same day
surgery)
Medical Coder
3. HCC (Hierarchical condition
categories)
4. ED department (E/M OP, E/M IP,
Observation, ED Facility, ED Profee)
Medical coding process in India based
Hospitals & Work Environment
❑ Few hospitals like JIPMER, PIMS, AIIMS few more hospitals have
been started doing their own coding and billing process which is like
USA healthcare and in future there is more demand for coders in
Indian health care sectors.
❑ Medical coding Companies are in all the metropolitan cities like
Chennai, Hyderabad, Trichy, Salem, Mumbai, Vizag, Vijayawada,
Vellore, Mysore, Noida, Pune, Jaipur, Trivandrum, Bangalore.
❑ All companies are like IT industry with a good professional
environment.
❑ Every individual gets equal opportunities to show their talents and
enhance their skills and knowledge.
❑ There will be targets to achieve daily with good quality and productivity.
Employee annual salary increment would depend on a few criteria like
Attendance, Production, Quality and their individual skills..
India
USA
Medical Coding Course Outline
Module 1
Medical Terminology &
Reference to Lab Values
Module 2
Anatomy & Physiology
Module 3
ICD 10 CM (International
classification of diseases &
Signs and symptoms 10th
revision clinical
modification) Assigning
codes for diseases
Module 4
CPT & HCPCS
CPT (Current procedural
terminology): Assigning codes for
procedures (Outpatient) For
inpatient by using PCS codes
(Procedural coding system)
HCPCS(Health care common
Procedural coding system):
Assigning codes for Materials
Module 1 & 2
➢ Medical Terminology - Medicine Has a
Language of Its Own
➢ Current medical vocabulary includes
terms built from Greek and Latin word
parts, eponyms, acronyms, and terms
from modern language
➢ Medical terms are like individual jigsaw
puzzles. They consist of (prefixes,
combining forms, and suffixes) that
make each term unique.
➢ Once you understand the basic medical
term structure and how these
components fit together, you will be able
to “build” almost any medical term.
➢ Basic Elements of a Medical Word
Word Root
Combining Form
Suffix
Prefix
➢ Human Body systems – The Human
body is bio-logical machine made of
body systems; Group of Organs that
work together to produce and sustain life
➢ There are 10 systems, which describe
about the body function
❖ Musculoskeletal system
❖ Cardiovascular system
❖ Respiratory system
❖ Integumentary system
❖ Nervous system
❖ Digestive system
❖ Urinary system
❖ Endocrine system
❖ Lymphatic system
❖ Reproductive system
Module 3 & 4
ICD 10 CM
o Min No of Digits - 3
o Max No of Digits - 7
o Chapters - 22
o No such Classification
o Incorporated in Chapters
o Laterality – RT and LT
o All Chapters are Alphanumeric
o Excludes Notes -1&2
o Dummy Place Holders – Yes -Xfor future expansion
ICD 9CM vs ICD 10CM Versions
ICD 9 CM
o Min No of Digits - 3
o Max No of Digits - 5
o Chapters - 17
o Supplemental Classification – V&E
codes
o Laterality – No
o Numeric Digits Except for - V& E
codes
o Excludes Notes - Yes
o Dummy Place Holders – No
a. ICD 10 CM (International
classification of diseases 10th
revision clinical modification)
Published by WHO (World health
organization)
b. Every year OCT 1st ICD 10 CM
Book will be updated
c. Structure of a code - starts with
Minimum 3 characters and
Maximum 7 characters
d. After every 3 digits there will be a
decimal point known as category
and All the codes are
Alphanumeric
e. ICD 10 CM consists of two
volumes Volume 1 is like
dictionary (all the disease
conditions, signs, symptoms, Ecauses are arranging in
alphabetical order)
f. Volume 1 consists of 2
Alphabetical Indexes (index to
disease & Injury, Index for
External causes) and 2 tabular
columns (Neoplasm table & Table
of Drugs and Chemicals)
g. Volume 2 is organized by chapter
specific it consists of 22 Chapters
Volume -1
• Alphabetical Index to
Diseases
• Main Term
Sub Term
Carry Over line
Carry Over line --
--Up to N Times
❖ Introduction to ICD
❖ Infections and parasitic
diseases
❖ Neoplasm
❖ Endocrine, nutritional,
metabolic diseases
❖ Blood and blood forming
organs
❖ Mental disorders
❖ Nervous system and sense
organs
❖ Circulatory system
❖ Respiratory system
❖ Digestive system
❖ Genitourinary system
❖ Complications of pregnancy
and abortions
❖ Skin and subcutaneous
❖ Musculoskeletal and
connective tissue
❖ Congenital anomalies
❖ Perinatal period conditions
❖ Signs and symptoms
❖ Injuries, poisoning and
complications
❖ COVID 19
Module 3 & 4
Cont. ICD 10 CM Features ICD 10 CM is Indented
Format
Volume – 2
• Tabular list of Diseases
• 22 Chapters
Sections
Category
Subcategory
• Structure of Code as below
Tabular List ICD 10 CM
❑ CPT (Current procedural terminology) –
Outpatient
❑ ICD 10-PCS –Procedural coding system
in Inpatient setting
❑ Published by AMA (American Medical
Association)
❑ Every year Jan 1st book will be revised
❑ All the codes are Numerical used to code
for medical and surgical procedures
❑ Book consists of Category 1, Category 2
& Category 3
❑ HCPCS (Health care common procedural
coding system)
❑ Published by AMA
❑ Every year Jan 1st book will be updated
❑ All the codes are Alphanumerical used
for coding materials and supplies
CPT & HCPCS
Features
Categories of CPT
This includes the following…
❑ Introduction to CPT
❑ Evaluation and Management
❑ Anesthesia
❑ Surgery (6 chapters) (Anatomical system)
❑ Radiology
❑ Pathology and Laboratory
❑ Medicine
❑ Modifiers
❑ Volume 3 (Procedures) (Hospital procedures)
Module 3 & 4 Cont.
Start career as Certified Medical coder
Which Certification is required to start career as a Medical Coder in
USA as well as other countries
▪ American Health Information Management Association (AHIMA)
▪ American Academy of professional Coding (AAPC) for US, Singapore,
Arab countries
▪ Certified Health Information Management (CHIM) professional in
Canada
▪ Health Information Management Association of Australia (HIMAA) -
ICD 10 AM
▪ Korean Accreditation Board for Health and Medical Information
Management Education (KAHIME)
▪ National Clinical Coding Qualification (UK).
Types of Coding Certifications From AAPC
Few certifications are listed here
▪ Certified Professional Coder (CPC®)
▪ Certified Outpatient Coding (COC®)
▪ Certified Inpatient Coder (CIC®)
▪ Certified Professional Medical Auditor (CPMA®)
▪ Certified Physician Practice Manager (CPPM®)
▪ Certified Professional Biller (CPB®)
How to enroll for a Certification
Link - https://www.aapc.com/certification/locate-examination.aspx
Details of CPC Certification
➢ It is an open book exam
➢ Duration is 4 hrs.
➢ Total Marks 100 Marks
➢ Pass percentage is 70%
➢ 2 Attempts
➢ All the questions are choosing the correct answers only
➢ No negative Marking
➢ OMR Sheet pattern
➢ ICD, MT, A&P, HCPCS & MB covers 30 questions and CPT covers 70 questions
Software Tools for Medical Coding
Which software is used in medical coding
▪ To complete the coding process more accurately, majority of the
medical coding companies uses some type of coding softwares.
▪ Software programs like below, where coders can enter the correct
procedure and diagnosis codes
❖ Epic
❖ Centricity
❖ AdvancedMD
❖ Flash Code
❖ Eclipse
❖ True code
❖ Webstrat
❖ 3M
❖ Tsystems
❖ Codify and others
3M Software Demo Find the code for Removal of foreign body
right auditory canal By using 3M software
▪ STEP 1: Select Male or Female for the
“Gender.”
▪ STEP 2: Type in an age.
▪ STEP 3: Click on the dropdown box
under “Product." Select
“HCPCS/CPTFINDER” and hit enter..
3M Software Demo – Cont. Find the code for Removal of foreign body
right auditory canal By using 3M software
▪ STEP 4: You should now be on the
“Patient Code Summary" page.
▪ STEP 5: On the left side of the screen,
click on “Add Procedure." You should now
be on the “Procedure Page.
3M Software Demo – Cont. Find the code for Removal of foreign body
right auditory canal By using 3M software
▪ STEP 6: In the “Enter Keyword or Code”
box, type in “Removal,” and hit enter.
▪ STEP 7: Select “Removal” (placing your
cursor over the word will bring up a
window with a description).
▪ STEP 8: Select “Foreign Body." You
should now be on the “Removal of Foreign
Body or Calculus/stone” screen.
▪ STEP 9: Select “Ear (Intraluminal).”
▪ STEP 10: Select “Unspecified” since it did
not notate what was being removed.
3M Software Demo – Cont. Find the code for Removal of foreign body
right auditory canal By using 3M software
▪ STEP 11: Select “Without General Anesthesia” since it did
not notate if anesthesia was used. You should now have
your code: 69200. However, we need to add a modifier
since we know the procedure was on the right ear.
▪ STEP 12: Click on the code description so it is highlighted
in gray.
▪ STEP 13: On the top of the screen, select “Options.”
▪ STEP 14: In the dropdown menu, select “Add/Delete
Modifier.”
▪ STEP 15: In the dropdown menu under “Modifier
Category,” select “All Modifiers.”
▪ STEP 16: Scroll through the modifiers until you find the
modifier “RT-Right side of body” and click “OK.”
▪ This will add the modifier to your code: 69200-RT.
Flash Code software Tool Outline
01 02
03
Review assigned medical records – do respective
selection of diagnosis and Procedure codes
Patient Encounters – List of charts to work per a day
Assign Alphanumeric code number for diagnosis
JD of a Medical Coding Trainee
Roles and Responsibilities of Medical coder
Prepare or arrange sequence of codes and get it
reviewed by Auditor 04
Example of Medical code
Case:
A 32 years old patient came with a complaint of Headache, Cough,
sore throat since from days came to emergency department to
evaluate
He does not have any history of smoking tobacco or alcohol and he
do not have allergy except Milk products and no chronic past medical
problems.
Investigations- CBP done normal levels, Throat culture ruled that
patient is positive for streptococcal bacteria, COVID test was
performed, and it was negative.
Clinical Impression doctor documented as Streptococcal Pharyngitis
Discharged to Home with Cefixim – 200 mg antibiotics for 5 days
once daily
How to code the above Example
Adx/RFV-Headache- R51
Pdx-Streptococcal Pharyngitis- J02.0per a day
▪ Medical billing is the process of collecting fees for medical service
▪ Medical billers take the codes prepared by the medical coder and
submit claims to the insurance company. They then follow up with
both the insurance company and the patients to make sure the
medical office is compensated properly, the patient is billed
correctly, and timely payments are made
▪ The Two Types of Medical Billing are:
➢ Professional billing is completed on the CMS-1500 Forms
➢ Institutional billing (Hospital Billing)-UB-04 (CMS-1450)
▪ Like MC software there are Medical Billing software's like
DrChrono, Kareo Billing, CureMD, AdvancedMD, CentralReach
▪ Medical billing software reduces the amount of work that doctors
and their staff to get bills paid; it helps ensure that medical
providers remain compliant with privacy laws like HIPPA, safe
and secure.
Medical Billing
❑ Certified Professional Biller (CPB)
❑ An understanding of various types of
insurance plans
❑ Expertise in applying payer policy, Local
Coverage Determinations (LCDs), and
National Coverage Determinations (NCDs)
for successful claim submissions
❑ Knowledge of CPT®, ICD-10-CM, and
HCPCS Level II coding guidelines
❑ Successful navigation of healthcare
industry rules and regulations, including
HIPAA, False Claims Act, Fair Debt
Collections Act, and Stark Law.
❑ An understanding of the life cycle of a
medical billing claim and how to improve
the revenue cycle
❑ Expertise in effective claim follow-up,
patient follow-up, and denial resolution.
135 multiple choice questions
4 hours to finish the exam
Open code book (manuals)
Types of Insurances: 29 questions
Managed care
Commercial payers
Medicare
Medigap
Medicaid
Blue Cross/Blue Shield
TRICARE/CHAMPUS
Worker's compensation
Third party payers (automobile, liability, etc.)
Certification for Medical Billing Certified Professional Biller(CPB) Exam structure
HIPPA & Compliance: 7 questions
HIPAA privacy
Billing compliance
Medical record retention
Financial policies
Fraud and abuse
Billing : 19 questions
Appeals
Denials
Claims tracking and follow-up
Timely filing
Demographics
Superbill/encounter forms
Retention of records
Balance billing
Telephone courtesy
Electronic claim submission
Clean claims
Audit the billing process
Billing Regulations: 17 questions
Accountable Care Organizations (ACO)
National Correct Coding Initiative (NCCI)
Local Coverage Determination (LCD)
National Coverage Determination (NCD)
Incident-to billing
Global packages
Unbundling
Completion of CMS-1500
Completion of UB-04
Payer payment policies
Reimbursement & Collections : 19 questions
Coding : 10 questions
10 questions
CPT®
ICD-10-CM
HCPCS Level II
Modifieras
34 questions on case studies.
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