Overview Of Icd-9 Coding

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Medicare Program was established when ?,with the passage of the Social Security Act

Back 1

1965

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Who was Medicare originally designed for?

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People 65 and over, then in 1972 people who were eligible for disability, end stage renal disease.

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Individuals covered under Medicare are termed ?

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beneficiaries

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Part A

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hospital insurance

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Part B

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supplemental medical insurance - pays for physician services and durable medical equipment.

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Part C

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known as Medicare Advantages Plan.
Beneficiaries must still have Part A and B. Gives the ability to select a plan that will that will also include supplemental insurance. Covers out of pocket costs.

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Part D

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called Prescription Drug Coverage. It can be purchased as part of a Medicare Advantage Plan or separately.

Front 8

What is the Federal Register ?

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is the official publication for all Presidential Documents. When the government makes changes they are published in the Federal Register. You must be aware of reimbursement changes to Medicare.

Front 9

What months does the Federal Register contains what information?

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the October edition contains hospital facility changes. and the November and December editions contains outpatient facility changes.

Front 10

Who is responsible for the Medicare Program ?

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Department of Health and Human Services.

Front 11

What part of Medicare pays for Hospice and some care services rendered in the home ?

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Part A

Front 12

Who is the largest third-party payer?

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Medicare Program

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The funds to run Medicare are generated from what ?

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the payroll taxes paid by employees and employers.

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Medicare pays ?? of allowable changes and the beneficiary pays the remaining 20%.

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80%

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Medicare A is funded through a payroll tax called the Federal Contribution Act called ? These taxes are paid by both the employer and employee. Medicare Part B, C, and D are purchased by the individual.

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FICA

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Are allowed full payment minus any copayments or individuals by Medicare.

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Participating Providers

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Are allowd 5 percent less than the standard payment for participating providers by Medicare

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Non-participating Providers

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The assisgnment of codes to diagnosis, services, and procedures based on patient record documentation

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Coding

Front 19

In 1992, the Resource - Based Relative Value Scale (RBVS) was established to reform physician payment procedures. Physicians are paid 80 percent of the allowed amount. No payment is made until the Medicare deductible is met.

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RBVS

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Fraud

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An intentional deception of misrepresentation of services that an individual knows to be false. Fraud is a felony. If convicted will face a fine of $25,000 or more and as many as 5years in jail.

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Abuse

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describes any incident or practice that is inconsistent with the industry's practice

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billing different rates to different carriers.

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HIPPA

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In 1996 the Health Insurance Portability Act was established for: 1 health coverage portability, 2 health insurance privacy, 3 administrative simplification, 4 medical savings accounts, 5 long-term care insurance.

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Code

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includes numeric and alphanumeric characters that are reported to health plams for health care reimbursement to external agencies for data collection and for education and research.

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Coding System

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organizes a medical nomenclature according to similar conditions, diseases, procedures, and services, and it contains codes to each.

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ICD-9CM

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was,adopted in 1979 to classify diagnoses and procedures, stands for International Classification of Diseases, Ninth Revision, Clinical Modification.

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CPT

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Current Procedure Terminology, classifies procedures and services and is used by physicians and outpatient health care settings.

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HCPCS

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Healthcare Common Procedure Coding System, also includes level Ii national codes called HCPCS II, which are managed by the Centers for Medicine (CMS), and Medicaid Services. Classifies medical equipment, injectable drugs, transportation servoces and other services .

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Medical nomenclature

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a vocabulary of clinic and medical (arthritis, gasteritis)terms used by health care providers to document patient care.

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ICD-10 CM

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to replace ICD-9 cm. Will be implemented on Oct 1, 2015. Stands for International Classification of Diseases Tenth Revision, Clinical Modification (Volumes 1 and 2.

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The funds to run Medicare are generated from what ?

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the payroll taxes paid by employees and employers

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FICA

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Medicare A is funded through a payroll tax called the Federal Contributions Act (FICA).

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CMS 1500 Form

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Physicians and other providers such as physical therapists submit their Medicare Part B on this form.

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CMS Form 1450

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Inpatient facilities, such as hospitals, submit their Medicare Part A claims on this form

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Subterms

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terms indented under main terms, considered essential modifers

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See category

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directs coder to use Volume 1 tabular list for additional information.

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See also

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directs code to look under another term if all information is not located under the first term.

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Bold type

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typeface used for all codes and titles in Volume 1

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Modifers

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terms in parentheses or terms following main term that may or may not be essential.

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Includes

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appears when a code to further define or explain the content.

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Excludes

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indicates terms that are to be coded elsewhere.

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Notes

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defines and gives instructions.

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Eponym

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diseases, procedures, or syndrome named for a person.

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Italics

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typeface used for all exclusion notes or diagnosis codes not to be used for first listed diagnosis.

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S bracket

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encloses a series of terms that modify the statement to the right.

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Brackets

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encloses synonyms, alteration words, or explanatory phases.

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Colon

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must be modified by an additional term to complete the code description.

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Parentheses

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encloses supplementary words that do not affect the code assignment.

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NEC

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indicates the use of code assignment for "other" when a more specific code does not exist.

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NOS

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equals unspecified.

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To locate the correct Icd-9 code

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use vol. 2 alphabetical vol. first, then verify the code in the tabular in vol. 1.

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Categories

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also called rubic, consists of 3 digits and represent the main term.

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Subcategory

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consists of 4 digits provides greater detail such as location.

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Subclassifications codes

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consists of 5 digits provides most specific details.

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Slanted brackets

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used in Volume 2 to enclose the disease manifestation codes that are sequenced after the underlying disease.

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Appendix A

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Morophology of Neoplasms

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Appendix B

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Deleted in 2004

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Appendix C

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Classifications of Drugs

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Appendix D

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Industrial Accidents

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Appendix E

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Three-digit Categories

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Cross References

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provide the coder with possible alternatives or synonyms for a term. there are three types of cross references: see, see also, and see category.