February 01, 2016
Medical coding plays a vital role in helping create accurate and reliable data that is required by the healthcare industry. The underlying principle has always been exercising integrity while coding. It is important to get the codes right while submitting any medical claim, and following the guidelines prescribed in the CPT® code book is an absolute necessity. The coding guidelines laid out in the book contain valuable information that tells you about proper code selection. More often than not, included are descriptions of procedures and other additional procedures that warrant billing when performed.
The rules found in ICD-9-CM and ICD-10-CM need not be the same. Hence, coders need to become thoroughly familiar with all the Official Coding Guidelines. You have the option of purchasing the ICD-10 guidelines or simply download them in order to become familiar with the latest updates and changes that are not found in ICD-9-CM. Please be informed that coding from the Alphabetic Index is not allowed. There may be incomplete codes that are identifiable simply with an a “-“, or you could be guided to a code that is somewhat less specific.
Coders also need to keep in mind that they need to thoroughly understand the proper, or rather authoritative sources of advice for coding for every single code. This is clearly defined in The Official Guidelines for Coding and Reporting, which have been approved by Cooperating Parties, comprising four organizations viz. American Health Information Management (AIHMA), American Hospital Association (AHA), the National Center for Health Statistics (NCHS), and Centers for Medicare and Medicaid Services (CMS). These are the official coding guidelines that are collectively promulgated by the Cooperative Parties, though none of the four organizations individually provide any sort of coding advice.
Coding from the Neoplasm Table is not allowed. As is the case with the Alphabetic Index, the Neoplasm Table too does not contain the complete code list as there are several variables that need to be considered while consulting the Tabular Index. There is always a 3-step process that needs to be followed while locating a code. You may begin with the Alphabetic Index for locating the condition or any such specific information. Next, the Tabular Index may be consulted, if the Alphabetic Index guides you there. Please make it a point to scan the codes before following them to ensure the accuracy level is maintained. Finally, you need to review the Official Coding Guidelines if you need any further guidance or clarification.
There is a red narrative in the Tabular Index in the AAPC ICD-10 CM code that needs to be consulted without fail. This is vital information that contains sequencing rules, notations for coding additional conditions whenever they are present, and more such valuable data. There are several indicators contained in the Tabular Index that identify the length of the code, and in which instances specific conditions should never be coded together.
While most coders would be familiar with ICD-9 as they may have used the same code set for the past several years, it may not be that easy with ICD-10. This is because of the inclusion of laterality, several temporal conditions, and many other modifying factors for every single code. Laterality need not always be uniform, although usually “1” denotes the right side and “2” the left, this is just a typical situation and can change at will. Also, the number of codes to be assigned would depend on the treatment of the condition, or conditions being dealt with.
Finally, ICD-9 and ICD-10 comprise different code sets; hence one cannot expect to find a similar number of codes to be reported. Manifestations and combination codes will decide upon the number of codes that are required.