Medical Billing & Coding Week 2
Welcome to week 2: the follow videos are a combination of topics included in medical billing and coding.
How to tab the ICD 10
The ICD-10-CM system is used to code medical records in healthcare settings. This lesson will discuss the basics of the ICD-10-CM system as well as some of its uses.
Coding for Medical Reimbursement
Joan is new at Crawford Ambulatory Center and is learning the coding system for medical reimbursement. During an evaluation, Joan asks her manager why ICD-10-CM codes are so important and have to be double checked with a doctor if there is a discrepancy. Joan feels that double checking information slows her productivity down. Her manager explains the purpose of the ICD-10-CM system.
Basics of the ICD-10-CM System
The first purpose of this international classification system was to identify causes of death. The ICD was started in 1893 and has grown over the years to include mortality and morbidity statistics as well. ICD-10-CM stands for International Classification of Diseases, Tenth Revision, Clinical Modification. The ICD is published by the World Health Organization (WHO) and is used globally as a diagnostic classification coding system that can also help researchers recognize and report health trends, diseases, and health conditions.
It helps communicate:
- Evidence-based information that is easily stored and readily available
- Medical information that is made public and can be compared between regions, countries, and hospitals
- Data that is tracked at different periods of time in the same locations to identify trends
The World Health Organization publishes the ICD
Joan did not know that the ICD system had been around for so long. She also did not realize that the medically coded information was used for more than just simple reporting and reimbursement. Joan’s manager continues to explain the importance of accurate ICD-10-CM system coding.
Uses of the ICD-10-CM System
As the ICD system has grown throughout the years, its purpose has expanded and its data is used for many different reasons. Specifically, the ICD-10-CM is used for:
- Assessing and monitoring the safety, efficacy, and quality of care
- Determining health policy
- Identifying public health risks
- Following utilization of resources
- Developing reimbursement and payment strategies for medical organizations and insurance companies
- Preventing and discovering fraud
- Researching and performing clinical trials and epidemiological studies
- Planning healthcare delivery systems
- Streamlining performance in departments of finance, administration, and clinical areas
- Tracking disease prevalence and occurrences of death
Joan is most interested in the ICD-10-CM’s uses for reimbursement and payment to her medical organization and partnered insurance companies. She knows that the codes represent certain information, such as types of diagnoses or disease, symptoms, procedures, reasons for medical visits, and health risks. For example, the code for type one diabetes is E10. If there are kidney complications caused by diabetes, a 2 is added: E10.2.
Joan’s manager reminds her that her knowledge of the ICD-10-CM codes in her scope of practice is extremely important in reporting patient and medical information to insurance companies and the state. Therefore, if some of the codes in a patient’s medical record do not match or relate to each other, they must be checked with the physician involved in that specific encounter. An error can prevent the organization from being reimbursed and will also report incorrect information for the ICD’s other purposes.
Joan understands and realizes that her job is truly important to the organization. She also likes the changes that were made in the ICD-10-CM revision.
Medical records must have accurate ICD codes
The medical record must have accurate ICD codes
ICD-10-CM Impact on Coding
The revisions made to ICD-10-CM are meant to improve coding, reporting, and documenting. More detailed coding allows for more specific information to be documented. The new codes include updated terminology and have clear directions for use. The revision also permits the use of non-specific codes when needed.
Joan feels more comfortable at her job now that she knows a slowdown in production will not be frowned upon. It may be necessary in order to ensure the correct ICD-10-CM codes are being reported. She is looking forward to a follow-up evaluation from her manager in several weeks so she can continue to improve at her new job.
Lesson Summary
- ICD-10-CM is published by the World Health Organization and is used globally.
- The ICD-10-CM system codes medical information that can be used to compare data in different areas and regions as well as tracked over periods of time.
- The ICD system was first used to identify causes of death.
- Over the years, the system has expanded to include codes that represent types of diagnoses or disease, symptoms, procedures, reasons for medical visits, and health risks.