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Understanding Medical Coding A Comprehensive Guide

by: Johnson, Sandra L.

Understanding Medical Coding A Comprehensive Guide

by: Johnson, Sandra L.

ISBN 13:
9781418010447
ISBN 10:
1418010448
Edition: 2nd
Format: Paperback
Copyright: 05/01/2006
Publisher: CENGAGE Delmar Learning
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Summary

Understanding Medical Coding, Second Edition is a practical and relevant guide for the modern health care environment. It provides an overview of CPT and ICD-9-CM coding, and addresses coding issues within specific coding content areas. This edition provides more code-specific information, concentrating on specialties and levels of coding. The book takes you through all steps necessary to code a claim correctly, link the correct codes for reimbursement for insurance carriers and government entities, and explains adjustments and how and when to bill patients. It even provides information on what to do if there is a denial or rejection. This is the product of choice for coding competency. Book jacket.

Preface	p. XIII
Introduction to Coding	p. 1
Introduction	p. 1
A Career as a Medical Coder	p. 2
What Skills are Required in Medical Coding?	p. 2
What Is Fraud and Abuse?	p. 4
Tools of the Trade	p. 5
Types of Coding	p. 6
ICD-10-CM	p. 8
ICD-9-CM	p. 11
Introduction	p. 11
History and Usage of ICD-9-CM	p. 11
How to Look Up a Term	p. 13
Tubular List	p. 15
V Codes and E Codes	p. 16
M Codes	p. 16
Categories, Subcategories, and Subclassifications	p. 16
Coding Conventions	p. 18
Review of the Basic Steps in Coding	p. 22
Procedural Coding with ICD-9-CM	p. 24
Infections	p. 32
HIV Infections	p. 33
Circulatory System Coding	p. 35
Diabetes Mellitus	p. 43
Using V Codes	p. 45
Obstetrical Coding	p. 48
Neoplasms	p. 55
E Coding	p. 60
Injuries	p. 63
Fractures	p. 64
Burns	p. 65
Poisoning Versus Adverse Effects	p. 68
Complications	p. 71
Late Effects	p. 72
Official Coding Guidelines	p. 74
ICD-10-CM	p. 78
Procedures in ICD-10-CM	p. 80
Implementation of ICD-10-CM	p. 81
Web Sites Related to ICD-10-CM	p. 82
HCPCS Level II	p. 85
Introduction	p. 85
History	p. 85
Format	p. 87
HCPCSII Hierarchy	p. 88
Code Revisions	p. 88
Index	p. 89
HCPCSII Chapter Details	p. 89
Accuracy Tips	p. 100
HCPCSII Medication Flow Chart	p. 100
Current Procedural Terminology (CPT) Basics	p. 103
Introduction	p. 103
AMA/CPT Code Book	p. 104
Symbols	p. 107
Unlisted Codes	p. 108
Sending Copies of Notes	p. 109
Illustrations	p. 109
Anesthesia	p. 109
CPT Surgical Guidelines	p. 109
Radiology and Pathology Guidelines	p. 111
Category II Codes	p. 112
Category III Codes	p. 112
CPT Errata	p. 113
Modifiers	p. 113
Appendix B	p. 121
Clinical Examples	p. 121
Appendix D	p. 122
Appendix E	p. 122
Appendix F	p. 122
Appendix G	p. 122
Appendix H	p. 122
Appendix I	p. 122
Index	p. 123
Tips for Selecting a CPT Code	p. 123
Evaluation and Management	p. 125
Introduction	p. 125
AMA/CPT Evaluation and Management (E/M) Guidelines	p. 126
Criteria of Documentation and E/M Code Selection per AMA/CPT	p. 128
More Details	p. 133
Time	p. 134
How to Select the E/M Code for the Most Common Encounters	p. 135
CMS 1995 Evaluation and Management Guidelines	p. 136
CMS 1997 Evaluation and Management Guidelines	p. 142
CPT Code Book	p. 161
Anesthesia/General Surgery	p. 181
Introduction	p. 181
Anesthesia	p. 181
Types of Anesthesia	p. 182
Anesthesia Coding	p. 182
General Surgery	p. 185
The Respiratory System	p. 186
The Cardiovascular System	p. 188
The Hemic and Lymphatic Systems	p. 191
The Mediastinum and Diaphragm	p. 191
The Digestive System	p. 191
The Urinary System	p. 198
The Male Genital System	p. 200
Laparoscopy/Hysteroscopy	p. 201
The Nervous System	p. 202
The Eye and Ocular Adnexa	p. 203
The Auditory System	p. 206
Integumentary System	p. 209
Introduction	p. 209
ICD-9-CM Code Selection	p. 210
Evaluation and Management Services for Integumentary/Skin	p. 215
Surgical Guidelines for Integumentary	p. 218
Incision and Drainage	p. 219
Debridement	p. 219
Paring or Cutting	p. 220
Biopsy	p. 220
Removal of Skin Tags	p. 221
Lesion Removal or Destruction	p. 221
Nails	p. 225
Intralesional Injections and Tissue Expanders	p. 226
Repair (Closures)	p. 226
Graft Concepts and Tips	p. 229
Adjacent Tissue Transfer of Rearrangement	p. 230
Free Skin Grafts	p. 233
Flaps (Skin and/or Deep Tissues)	p. 234
Other Procedures	p. 235
Pressure Ulcers (Decubitus Ulcers)	p. 236
Burns, Local Treatment	p. 236
Destruction	p. 237
Moh's Micrographic Surgery	p. 239
Breast Procedures	p. 240
Repair and/or Reconstruction	p. 241
Orthopedics	p. 245
Introduction	p. 245
Fractures	p. 247
Dislocations	p. 257
Arthropathy	p. 260
Vertebral Disorders	p. 266
Sprains and Strains	p. 270
Other Conditions and Procedures	p. 270
Cardiology and the Cardiovascular System	p. 273
Introduction	p. 273
Cardiac and Vascular Anatomy and Physiology	p. 275
ICD-9-CM Code Selection	p. 279
CPT	p. 284
90000 Series of CPT	p. 287
Intracardiac Electrophysiological Procedures/Studies	p. 294
Other Vascular Studies	p. 296
Noninvasive Vascular Diagnostic Studies	p. 296
30000 Series of CPT	p. 297
Radiology	p. 309
Using Modifiers Effectively	p. 327
Considering an Unlisted Code? Category II	p. 327
Category II Codes	p. 328
OB/GYN	p. 331
Introduction	p. 331
Unique Aspects of Coding OB/GYN	p. 332
Subspecialties of OB/GYN	p. 332
Anatomy and Physiology of the Female Reproductive System	p. 332
Obstetrics and Gynecology (OB/GYN)	p. 338
Obstetrics (OB)	p. 341
Radiology, Pathology, and Laboratory	p. 385
Introduction	p. 385
Radiology	p. 385
CPT-Radiology	p. 386
Radiology Modifiers	p. 387
Dignostic Radiology (Diagnostic Imaging)	p. 389
Diagnostic Ultrasound	p. 389
Radiation Oncology	p. 391
Nuclear Medicine	p. 393
CPT-Pathology and Laboratory	p. 399
Organ or Disease Oriented Panels	p. 403
Evocative/Suppression Testing	p. 403
Chemistry	p. 403
Hematology and Coagulation	p. 404
Immunology	p. 404
Transfusion Medicine	p. 404
Microbiology	p. 404
Anatomic Pathology	p. 405
Cytopathology	p. 405
Surgical Pathology	p. 405
Medicine	p. 409
Introduction	p. 409
Medicine Guidelines	p. 409
Immune Globulins	p. 411
Immunization Administration	p. 411
Vaccines and Toxoids	p. 413
Therapeutic Infusions	p. 413
Injections	p. 413
Psychiatry	p. 413
Psychiatric Therapeutic Care	p. 414
Biofeedback	p. 414
Dialysis	p. 414
Gastroenterology	p. 415
Ophthalmology	p. 415
Otorhinolaryngology Services	p. 417
Cardiology	p. 417
Pulmonary	p. 417
Allergy and Clinical Immunology	p. 418
Endocrinology	p. 418
Neurology and Neuromuscular Procedures	p. 419
Central Nervous System Assessments/Tests	p. 419
Health and Behavior Assessment	p. 419
Chemotherapy Administration	p. 420
Photodynamic Therapy and Dermatological Procedures	p. 420
Physical Medicine and Rehabilitation	p. 420
Medical Nutrition Therapy	p. 421
Acupuncture	p. 421
Osteopathic Manipulation	p. 422
Chiropractic Manipulative Treatment	p. 422
Special Services	p. 422
Qualifying Circumstances for Anesthesia	p. 423
Home Health Procedures	p. 424
Billings and Collections	p. 425
Introduction	p. 425
Patient Registration	p. 426
Ambulatory Patient Groups	p. 430
Payment and Billing Processes	p. 430
Billing	p. 435
The Billing Process	p. 447
The Collections Process	p. 449
Collection Techniques	p. 451
Professional Courtesy	p. 462
Filing the Claim Form	p. 465
Introduction	p. 465
The Health Insurance Claim Form	p. 467
Medicaid	p. 484
Medicare	p. 488
Medicare as Secondary Payer	p. 500
Submitting a Claim for a Deceased Patient	p. 500
Health Maintenance Organizations (HMOS)	p. 501
Champus/Tricare/Champva	p. 502
Workers' Compensation	p. 506
Blue Cross/Blue Shield	p. 508
Electronic Claim Processing	p. 511
Insurance Claims Follow-Up	p. 512
Payment for Professional Health Care Services, Auditing, and Appeals	p. 529
Introduction	p. 529
Payment Cycle	p. 530
Encounter Forms, Superbills, Fee Slips, or Charge Tickets	p. 535
Step-By-Step Completion of a Paper CMS 1500 Form	p. 539
Payer Receipt of the Claim	p. 542
Follow-Up	p. 542
Accuracy of Payment on Arrival	p. 542
Appealing the Claim	p. 543
Insurance Participation Agreements (Contracts)	p. 549
Denials and Rejections	p. 556
Appeals	p. 557
Mirrored Image of the Documentation	p. 558
Risky Behavior	p. 558
Auditing	p. 559
The Office of Inspector General	p. 563
Steps to Take When an Investigator Arrives	p. 563
Fraud Risk Prevention	p. 565
Penalties	p. 566
Health Insurance Portability and Accountability Act (HIPAA)	p. 566
Inpatient Coding	p. 569
Introduction	p. 569
Hospital Based ICD-9-CM Coding	p. 570
Unconfirmed Conditions	p. 574
Code Assignment	p. 577
Coding Guidelines	p. 582
Hospital Reimbursement Environment	p. 583
Glossary	p. 593
Index	p. 607
Table of Contents provided by Ingram. All Rights Reserved.

Amazon no longer offers textbook rentals. We do!

Understanding Medical Coding A Comprehensive Guide

Understanding Medical Coding A Comprehensive Guide

9781418010447

1418010448

Summary

Table of Contents

Supplemental Materials

Write a Review

Amazon no longer offers textbook rentals. We do!

Understanding Medical Coding A Comprehensive Guide

Understanding Medical Coding A Comprehensive Guide

9781418010447

1418010448

Summary

Table of Contents

Supplemental Materials

Write a Review

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