MEDICAL CODING

MEDICAL CODING

1. Mushtaq Ahmad Wani
15PIM2244
M.S. (Pharm.) 3
rd
Semester
Department Of Pharmacoinformatics
NIPER, S.A.S. Nagar
1
Medical coding systems

2. 2
Medical coding or, medical classification is the process
of transforming descriptions of medical diagnoses and
procedures into universal medical code numbers
 The diagnoses and procedures are usually taken from a
variety of sources within the health care records, such as
the transcription of the physician's notes, laboratory
results, radiologic results
Medical coding systems.

3. 3
Diagnostic codes
Are used to determine diseases, disorders, and
symptoms
Can be used to measure morbidity and mortality
Examples: ICD-9-CM, ICD-10
Procedural codes
They are numbers or alphanumeric codes used to
identify specific health interventions taken by medical
professionals.
Examples: CPT
Pharmaceutical codes
Are used to identify medications
Examples: NDC

4. 1.ICD-9-CM
4
International Classification of Diseases, Ninth Revision, clinical
modification
ICD codes are used to represent a doctor’s diagnosis and patient’s condition
Developed by W.H.O in 1948 to track diseases
ICD codes are updated by NCHS by daily basis
US currently coding in ICD-9-CM systems
In the billing process, ICD is used to determine medical necessity

5. 5
Clinical modification is a set of revisions created by the National Center
for Health Statistics(NCHS)
Clinical modification gives coders much more flexibility and specificity
Ex.ICD-10 has 14,000 codes
but ICD-10-CM has 68,000+codes
ICD-9-CM has reached its capacity of use as a coding systems
ICD-9-CM changeover to ICD-10-CM in october of 2014
ICD-10-CM provides more codes, more flexibility and accuracy in the
coding process
Clinical modification

6. Anatomy of ICD-9 Code
6

7. Organization of ICD-9 Volume 1
001-139Infectious and Parasitic Diseases
140-239 Neoplasms
240-279Endocrine, Nutritional and Metabolic Diseases
280-289Diseases of the Blood and Blood-forming Organs
290-319Mental Disorders
320-389Diseases of the Nervous System and Sense Organs
390-459Diseases of the Circulatory System
460-519Diseases of the Respiratory System
520-579Diseases of the Digestive System
580-589Diseases of the Genitourinary System
630-676Complications of Pregnancy, Childbirth, and the
Puerperium
680-709Diseases of the Skin and Subcutaneous Tissue
7

8. Organization of ICD-9 Volume 1
710-739Diseases of the Musculoskeletal System & Connective
Tissue
740-759Congenital Anomalies
760-779Certain Conditions Originating in the Perinatal Period
780-799Symptoms, Signs and Ill-defined Conditions
800-999Injury and Poisoning
E800-E999Supplementary Classification of the External Causes of
Injury and Poisoning
V01-V82Supplementary Classification of factors influencing
Health Status and Contact with Health Services
8

9. Example
Turn to that ICD code in Volume 1

786.5Chest pain
786.50 Chest pain, unspecified
786.51 Precordial pain
786.52 Painful respiration
Pain:Pleurodynia
anterior chest wall
pleuritic
786.59 Other
Discomfort
Pressure in chest
Tightness
EXCLUDES
9

10. 2.CPT
10
Current procedural Terminology
Systematic listing of procedures & services performed by
physicians
Five-digit codes for procedures or services
Used to describe the physician’s services to a patient for
diagnosis and treatment of the medical condition(s)
Codes and descriptive terminology developed and copyrighted
by AMA CPT Editorial Panel

11. Organization of CPT Manual
11
Text organized in 6 major sections
Evaluation and Management(99201 - 99499)
Anesthesiology (00100 - 01999, 99100-99140)
Surgery (10040 - 69990)
Radiology (70010 - 79999)
Pathology and Laboratory (80049 - 89399)
Medicine (90281 - 99199)

12. Example
Electrocardiogram (ECG or EKG) (CPT 93000)
Procedure code and description
93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and
report
93005 - Electrocardiogram, routine ECG with at least 12 leads; tracing only, without
interpretation and report
93010 - Electrocardiogram, routine ECG with at least 12 leads; interpretation and report
only
93040 - Rhythm ECG, 1-3 leads; with interpretation and report
93041 - Rhythm ECG, 1-3 leads; tracing only without interpretation and report
93042 - Rhythm ECG, 1-3 leads; interpretation and report only
12

13. 3. NDC
13
The NDC, or National Drug Code, is a unique 10-digit, 3-segment number
It is a universal product identifier for human drugs in the United States
 The code is present on all nonprescription (OTC) and prescription
medication packages and inserts in the US
The 3 segments of the NDC code:
I.The first set of numbers in the NDC identifies the labeler (manufacturer,
repackager, or distributer).
II.The second set of numbers is the product code, which identifies the specific
strength, dosage form (i.e, capsule, tablet, liquid)
III.the third set is the package code, which identifies package sizes and types.

14. Example
The NDC for a 100-count bottle of Prozac 20 mg is 0777-3105-02
14

15. 15