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With coverage of both inpatient and outpatient coding, UNDERSTANDING MEDICAL CODING: A COMPREHENSIVE GUIDE, THIRD EDITION teaches students everything they need to know about medical coding. Through clear, step-by-step instructions, students are taught how to code a claim correctly, link the correct CPT and ICD-9-CM codes for reimbursement, understand adjustments as well as how and when to bill patients, and determine what to do if there is a denial or rejection. Coverage has been thoroughly updated to include information on ICD-10-CM and how it compares to ICD-9-CM. CPT coding and modifiers are also discussed, as well as more code-specific information, concentrating on specialty coding and the levels of coding. Additional case studies, practice exercises, tips, examples, tables, charts, and photos have been added in order to improve student performance and ensure that they are well prepared for a medical coding position in a variety of settings.
- The text has been updated to include the most recent information on topics such as HIPAA and new legislation.
- A new chapter on CPT modifiers has been added for more comprehensive coverage.
- Additional tips, examples, tables, charts, and photos have been added to supplement the text material.
- Four color design augments an enhanced art program, with more anatomy and diagnoses images for clearer understanding.
- Additional case studies and practice exercises are included in both the text and the workbook to help students master the material.
- Information on the industry shift to ICD-10-CM, its history, implementation and how it compares to ICD-9-CM.
- HIPAA, Coder Tips, and Alerts are very helpful instructional fields.
- This text walks students through the steps of accurate code selection in order to ensure optimal payment of medical services.
- Outpatient and inpatient coding are addressed in detail.
- This text covers all aspects of billing, reimbursement, and collections issues so that students are prepared to work in any medical billing setting
- Step-by-step instructions for claim submission for various insurance carriers are included.
1. Introduction to Coding.
Introduction. A Career As a Medical Coder. What Skills are Required in Medical Coding? What is Fraud and Abuse? Tools of the Trade. Types of Coding. ICD-10CM.
Introduction. History and Usage of ICD-9-CM. How to Look Up a Term. Tabular List. V Codes and E Codes. M Codes. Categories, Subcategories, and Subclassifications. Coding Conventions. Review of the Basic Steps in Coding. Procedural Coding with ICD-9-CM. Infections. HIV Infections. Circulatory System Coding. Diabetes Mellitus. Using V Codes. Obstetrical Coding. Neoplasms. E Coding. Injuries. Fractures. Burns. Poisoning versus Adverse Effects. Complications. Late Effects. Official Coding Guidelines. ICD-10-CM. Procedures in ICD-10-CM. Implementation of ICD-10-CM. Web Sites Related to ICD-10-CM.
3. HCPCS Level II.
Introduction. History. Format. HCPCSII Hierarchy. Code Revisions. Index. HCPCSII Chapter Details. Accuracy Tips. HCPCSII Medication Flow Chart.
4. Current Procedural Terminology (CPT) Basics.
Introduction. AAMA/CPT Code Book. Symbols. Unlisted Codes. Sending Copies of Notes. Illustrations. Anesthesia. CPT Surgical Guidelines. Radiology and Pathology Guidelines. Category II Codes. Category III Codes. CPT Errata. Appendix A- Modifiers. Appendix B. Appendix C- Clinical Examples. Appendix D. Appendix E. Appendix F. Appendix G. Appendix H. Appendix I. Index. Tips for Selecting a CPT Code.
5. Evaluation and Management.
Introduction. AMA/CPT Evaluation and Management (E/M) Guidelines. Criteria of Documentation and E/M Code Selection per AMA/CPT. More Details. Time. How to Select the C/M Code for the Most Common Encounters. CMS 1995 Evaluation and Management Guidelines. CMS 1997 Evaluation and Management Guidelines. CPT Code Book.
6. Anesthesia/General Surgery.
Introduction. Anesthesia. Types of Anesthesia. Anesthesia Coding. General Surgery. The Respiratory System. The Cardiovascular System. The Hemic and Lymphatic Systems. The Mediastinum and Diaphragm. The Digestive System. The Urinary System. The Male Genital System. Laparoscopy/Hysteroscopy. The Nervous System. The Eye and Ocular Adnexa. The Auditory System.
7. Integumentary System.
Introduction. ICD-9-CM Code Selection. Evaluation and Management Services for Integumentary/Skin. Surgical Guidelines for Integumentary System. Incision and Drainage. Debridement. Paring or Cutting. Biopsy. Removal of Skin Tags. Lesion Removal or Destruction. Nails. Intralesional Injections and Tissue Expanders. Repair (Closures). Graft Concepts and Tips. Adjacent Tissue Transfer of Rearrangement. Free Skin Grafts. Flaps (Skin and/or Deep Tissues). Other Procedures. Pressure Ulcers (Decubitus Uclers). Burns, Local Treatment. Destruction. Moh''s Micrographic Surgery. Breast Procedures. Repair and/or Reconstruction.
Introduction. Fractures. Dislocations. Arthropathy. Vertebral Disorders. Sprains and Strains. Other Conditions and Procedures.
9. Cardiology and the Cardiovascular System.
Introduction. Cardiac and Vascular Anatomy and Physiology. ICD-9-CM Code Selection. CPT. 90000 Series of CPT. Intra-cardiac Electrophysiological Procedure/Studies. Other Vascular Studies. Noninvasive Vascular Diagnostic Studies. 30000 Series of CPT. Radiology. Using Modifiers Effectively. Considering an Unlisted Code – Category II. Category II Codes
Introduction. Unique Aspects of Coding OB/GYN. Subspecialties of OB/GYN. Anatomy and Physiology of the Female Reproductive System. Obstetrics and Gynecology (OB/GYN). Obstetrics (OB)
11. Radiology, Pathology, and Laboratory.
Introduction. Radiology. CPT – Radiology. Radiology Modifiers. Diagnostic Radiology (Diagnostic Imaging). Diagnostic Ultrasound. Radiation Oncology. Nuclear Medicine. CPT – Pathology and Laboratory. Organ or Disease Oriented Panels. Evocative/Suppression Testing. Chemistry. Hematology and Coagulation. Immunology. Transfusion Medicine. Microbiology. Anatomic Pathology. Cytopathology. Surgical Pathology.
Introduction. Medicine Guidelines. Immune Globulins. Immunization Administration. Vaccines and Toxoids. Therapeutic Infusions. Injections. Psychiatry. Psychiatric Therapeutic Care. Biofeedback. Dialysis. Gastroenterology. Ophthalmology. Otorhinolaryngology Services. Cardiology. Pulmonary. Allergy and Clinical Immunology. Endocrinology. Neurology and Neuromuscular Procedures. Central Nervous System Assessments/Tests. Health and Behavior Assessment. Chemotherapy Administration. Photodynamic Therapy and Dermatological Procedures. Physical Medicine and Rehabilitation. Medical Nutrition Therapy. Acupuncture. Osteopathic Manipulation. Chiropractic Manipulative Treatment. Special Services. Qualifying Circumstances for Anesthesia. Home Health Procedures.
Introduction. CPT Modifiers. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use. HCPCS Level II Modifiers. NCCI Modifiers. Category II Modifiers.
14. Billing and Collections.
Introduction. Patient Registration. Payment and Billing Processes. Billing. The Billing Process. The Collections Process. Collection Techniques. Professional Courtesy.
15. Filing the Claim Form.
Introduction. The Health Insurance Claim Form. Medicaid. Medicare. Medicare as Secondary Payer. Submitting a Claim for a Deceased Patient. Health Maintenance Organizations (HMOs). Champus/Tricare/Champva. Workers'' Compensation. Blue Cross/Blue Shield. Electronic Claim Processing. Insurance Claims Followup.
16. Payment for Professional Health Care Services, Auditing, and Appeals.
Introduction. Payment Cycle. Encounter Forms, Superbills, Fee Slips, or Charge Tickets. Step-by-Step Completion of a Paper CMS 1500 Form. Payer Receipt of the Claim. Follow-Up. Accuracy of Payment on Arrival. Appealing of the Claim. Insurance Participation Agreements (Contracts). Denials and Rejections. Appeals. Mirrored Image of the Documentation. Risky Behavior. Auditing. The Office of Inspector General. Steps to Take When An Investigator Arrives. Fraud Risk Prevention. Penalties. Health Insurance Portability and Accountability Act (HIPAA).
17. Inpatient Coding.
Introduction. Hospital-based ICD-9-CM Coding. Unconfirmed Conditions. Code Assignment. Coding Guidelines. Hospital Reimbursement Environment.
Cengage provides a range of supplements that are updated in coordination with the main title selection. For more information about these supplements, contact your Learning Consultant.
The instructor's Manual serves as an instructional resource and provides teaching tips or guidelines, essay questions, answers to review and test questions, key objectives, glossary, appendices and exercises for content reinforcement.
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