Medical coding 14-07-2024.pptx on medical

on medical coding

1. Medical coding POOJA TIWARI (M PHARMACOLOGY) CPC certified medical coder (2017) 5+ years of industrial experience AS A QUALITY ANALYST . 2yrs EXPERIENCE as a LECTURER Speaker :

2. Definition of medical coding Medical coding is the process of assigning standardized codes to medical procedures, diagnoses, and services. These codes are used for various purposes, including billing, reimbursement, research, and quality assessment. Medical coding translates complex medical terms and procedures into a standardized format that can be easily understood and interpreted by healthcare professionals, insurance companies, and other stakeholders in the healthcare industry.

3. History of medical coding The history of medical coding can be traced back to the early 20 th century, when the use of standardised classification systems for diseases and medical procedures began to gain popularity. In 1900, the Bertillon Classification of Causes of Death was introduced, which was used to classify and track mortality statistics. . In 1910, the International Classification of Diseases (ICD) was introduced by the World Health Organization (WHO) as a standardised system for coding diagnoses and diseases. . In the 1960s, the American Medical Association (AMA) introduced the Current Procedural Terminology (CPT) coding system, which was designed to standardise the coding of medical procedures and services provided by physicians and other healthcare providers.

4. Medical coding and its importance in healthcare . Medical coding is a critical process in healthcare that involves the transformation of complex medical procedures and diagnoses into a standardized code format. These codes are used for many purposes, including billing, reimbursement, research, and quality assessment. Medical coding is essential for the effective functioning of healthcare systems and the delivery of quality patient care

5. Types of medical codes There are two main types of medical codes: Current Procedural Terminology (CPT) codes and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. CPT codes are used to describe medical procedures and services. These codes are created and maintained by the American Medical Association (AMA) and are updated annually to reflect changes in medical practice. ICD-10-CM codes are used to describe medical diagnoses and conditions. These codes are maintained by the World Health Organization (WHO) and are used by healthcare providers and insurance companies worldwide. Together, these two types of codes provide a comprehensive system for describing and communicating medical procedures, diagnoses, and services in a standardized format.

6. CPT-Current Procedural Terminology CPT codes consist of five digits, and each code represents a specific medical procedure or service. CPT codes are organized into three categories: Category I, Category II, and Category III codes. Category I codes are the most commonly used and describe medical procedures and services that are widely performed Category II codes are used to report performance measures, while Category III codes are temporary codes used to describe emerging technologies and procedures that do not yet have a Category I code.

7. Here are some examples of CPT codes and how they are used. 99213 – This code is used to describe a mid-level office visit with an established patient. This might include a brief examination, review of medical history, and a prescription refill. 45378 – This code is used to describe a colonoscopy procedure. This might include the insertion of a flexible tube with a camera into the colon to examine the inside of the colon for abnormalities or disease. CPT codes are used to describe a wide variety of medical procedures and services, and they play a crucial role in the medical billing and reimbursement process.

8. ICD-10-CM codes - ICD-10-CM codes are a standardized set of codes used to describe medical diagnoses and conditions. The codes were developed and are maintained by the World Health Organization (WHO) and are used by healthcare providers and insurance companies worldwide. ICD-10-CM codes consist of alphanumeric characters and are up to seven digits in length. ICD-10-CM codes are organized into chapters based on the body system or condition being described. ICD-10-CM codes are used by healthcare providers to document patient diagnoses in medical records, and they are used by insurance companies to determine coverage and reimbursement for medical services.

9. Here are some examples of ICD-10-CM codes and how they are used. J45.909 – This code is used to describe uncomplicated asthma. It is used by healthcare providers to document the patient’s diagnosis in their medical record, and it is used by insurance companies to determine coverage and reimbursement for asthma-related medical services. E11.9 – This code is used to describe type 2 diabetes mellitus without complications. It is used by healthcare providers to document the patient’s diagnosis in their medical record, and it is used by insurance companies to determine coverage and reimbursement for diabetes-related medical services.

10. Medical coding is important for a number of reasons. The importance of accurate medical coding in healthcare, such as ensuring proper reimbursement, tracking disease patterns, and facilitating research. Medical coding is essential to the functioning of the healthcare system. Accurate and consistent coding helps to ensure that patients receive appropriate care, healthcare providers are properly reimbursed, and research and public health initiatives are supported.

11. Medical coding guidelines. Ensuring accurate and consistent coding Complying with legal and regulatory requirements Maximizing reimbursement Maintaining data integrity Coding guidelines such as those set by CMS is essential to ensure accurate and consistent coding, comply with legal and regulatory requirements, maximize reimbursement, and maintain data integrity.

12. The RCM cycle or Revenue Cycle ManagemenT Encounter – Face to Face encounter with doctor Transcription- Converts the audio data in medical record Medical coding – Convert the whole medical record into Alfa- Numeric codes Medical billing – Post the payment and charges of the given code to insurance company AR – Denial management and watch on doctor collection.

13. Medical record documentation. Documentation provides the basis for coding Documentation must be specific Documentation must be timely Documentation must be consistent

14. Types of medical record documentation. Progress notes. Operative reports Diagnostic test results Consultation notes Medication lists Accurate and complete documentation is essential for assigning accurate diagnosis and procedure codes, which is critical for reimbursement, research, and patient care.

15. Coding accuracy Coding accuracy is critical in healthcare because it impacts not only reimbursement but also patient care and legal compliance. Reimbursement Legal compliance Patient care Research Reputation It is essential for healthcare providers to prioritize coding accuracy and ensure that they have processes and systems in place to prevent coding errors.

16. Challenges of medical coding Medical coding can be challenging due to several factors. Changes in coding guidelines Complexity of medical procedures Specificity of codes Electronic health record (EHR) systems Billing and reimbursement

17. Medical coding career Medical coding offers a variety of career opportunities, each with its own unique responsibilities and requirements. Medical Coder Medical Biller Coding Auditor Coding Manager Medical coding offers a range of career opportunities, each with its own unique responsibilities and requirements.

18. Conclusion Medical coding is an essential process in healthcare that involves translating medical procedures and diagnoses into standardized codes. There are two primary types of medical codes: CPT codes, which are used to describe medical procedures, and ICD-10-CM codes, which are used to describe diagnoses and conditions. Medical coding offers a variety of career opportunities, including medical coder, medical biller, coding auditor, and coding manager. Inaccurate medical coding can have significant consequences, including incorrect reimbursement and potential legal issues.

19. Question?

20. Interview questions 1. What do you know about medical coding, and why did you choose to pursue a career in this field? 2. What coding systems have you studied or worked with during your training or education? 3. How do you ensure accuracy and compliance with coding guidelines? 4. How do you stay up to date with changes in coding regulations and guidelines? 5. Can you provide an example of a coding challenge you have faced during your training, and how you resolved it?

21. Interview questions 6. How do you prioritize your coding workload when faced with multiple tasks and deadlines?
7. Have you had any experience with electronic health records (EHRs)? If so, which ones?
8. How do you ensure patient confidentiality and privacy in your coding work? 9. How do you handle conflicting information or missing documentation in medical records? 10. How do you handle feedback and criticism in your work?

22. Human anatomy and physiology questions What is the function of the gastrointestinal (GI) system? -The GI system is responsible for the digestion and absorption of nutrients, as well as the elimination of waste from the body.
What are the main organs of the GI system?
The main organs include the mouth, esophagus , stomach, small intestine (duodenum, jejunum, ileum), large intestine (colon), rectum, and anus.

23. What are the primary functions of the stomach?
The stomach serves to store food, mix it with gastric juices, initiate protein digestion with pepsin, and regulate the release of partially digested food ( chyme ) into the small intestine.
What is the role of the small intestine in digestion and absorption?
The small intestine is where most of the digestion and absorption of nutrients occurs. Enzymes from the pancreas and bile from the liver aid in the breakdown of carbohydrates, proteins, and fats, while nutrients are absorbed through the intestinal lining into the bloodstream.

24. What is the function of the large intestine?
The large intestine primarily absorbs water and electrolytes from the remaining indigestible food material, forming feces for elimination.
What are common disorders of the GI system?
Common disorders include gastroesophageal reflux disease (GERD), peptic ulcers, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), irritable bowel syndrome (IBS), and colorectal cancer.

25. What is the cardiovascular system?
The cardiovascular system, also known as the circulatory system, is responsible for circulating blood and transporting nutrients, oxygen, hormones, and waste products throughout the body.
What are the main components of the cardiovascular system?
The main components include the heart, blood vessels (arteries, veins, and capillaries), and blood.

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