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MEDICAL
CODING
INTRODUCTION FOR A CAREER
Presented by Lyn Olsen,Ph.D., MPA, RHIT,
CCS, CPC-H, CCS-P, CPC
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WHAT IS MEDICAL
CODING AND BILLING?
• MEDICAL CODING & BILLING ARE THE CORE OF
ADMINISTRATIVE MEANS BY WHICH HEALTHCARE
PROVIDERS ARE PAID
• INVOLVES ABUNDANT REGULATIONS BY A MULTITUDE
OF GOVERNMENT AGENCIES WITH SERIOUS FINES FOR
FRAUD AND/OR ABUSE (check websites www.cms.gov
and www.oig.hhs.gov for more information)
• IF CODERS AND BILLERS FAIL TO DO THEIR JOB WELL,
HOSPITALS AND DOCTORS MAY BE UNABLE TO
PRACTICE AND PATIENTS MAY NOT BE ABLE TO RECEIVE
PROPER SERVICES
ICD-9
• ICD IS THE INTERNATIONAL CLASSIFICATION OF DISEASES AS DEVELOPED
BY THE WORLD HEALTH ORGANIZATION TO TRACK THE OCCURRENCES OF
DISEASES SO THAT PATIENTS CAN BE MORE EFFECTIVELY TREATED
• UNITED STATES USES THIS SYSTEM TO SELECT DIAGNOSTIC CODES AS
PART OF THE PAYMENT PROCESS TO ENSURE MEDICAL NECESSITY
• ICD CODES ARE NUMERIC AND CAN VARY FROM 3 DIGITS TO 5 DIGITS
WITH THE 4TH AND 5TH DIGITS LOCATED TO THE RIGHT OF THE PERIOD
AND THE REST OF THE DIGITS ARE LOCATED TO THE LEFT
• THERE ARE TWO ADDITIONAL SECTIONS FOR E (EXTERNAL INFLUENCES)
CODES AND V CODES (SUPPLEMENTAL CODES)
• THERE ARE THREE VOLUMES CONTAINED WITHIN ONE BOOK:
– VOLUME 1 IS THE TABULAR INDEX OR CODES
– VOLUME 2 IS THE ALPHABETICAL INDEX
– VOLUME 3 IS THE TABULAR INDEX OF HOSPITAL PROCEDURES AND IS
NOT USED BY PHYSICIANS OR HEALTHCARE PROVIDERS BECAUSE
THEY USE THE CPT CODES
CPT
• CPT IS THE CURRENT PROCEDURAL TERMINOLOGY
WHICH IS DEVELOPED BY THE AMERICAN MEDICAL
ASSOCIATION
• CPT PROVDES CODES FOR VARIOUS SERVICES
PROVIDED BY HEALTHCARE PROVIDERS, SUCH AS
DOCTORS AND TECHNICIANS
• CPT BOOK IS COMPOSED OF CODES AND AN
ALPHABETICAL INDEX
• CPT BOOK ALSO HAS APPENDICES WHICH ARE
IMPORTANT WITH USE OF CODES, SUCH AS THE
MODIFIERS
• CPT CODES ARE 5 DIGITS NUMERIC AND MODIFIERS
CAN BE ATTACHED MARKED BY A HYPHEN BETWEEN
THE CPT CODE AND THE MODIFIER
• SECTIONS OF THE CPT BOOK INCLUDE EVALUATION &
MANAGEMENT FOR VISITS, ANESTHESIOLOGY,
SURGERY, RADIOLOGY, LABORATORY/PATHOLOGY AND
MEDICINE.
HCPCS
• HEALTHCARE COMMON PROCEDURE CODING SYSTEM
(HCPCS)
• HCPCS LEVEL I ARE THE CPT CODES
• LEVEL II ARE ALPHANUMERIC AND DEVELOPED BY THE
CENTERS FOR MEDICAID AND MEDICARE SERVICES (CMS), A
PART OF THE HEALTH AND HUMAN SERVICES FEDERAL
DEPARTMENT.
• LEVEL II CODES ARE USED TO CODE FOR PAYMENT OF NONPHYSICIAN SERVICES INCLUDING AMBULANCE SERVICES,
PROSTHETIC DEVICES, AND SUPPLIES AND MATERIALS
INCLUDING DRUGS AND MEDICATIONS.
• HCPCS ALSO HAVE MODIFIERS
MEDICAL CODING
AS A CAREER CHOICE
• AS A CAREER, MEDICAL CODING AND BILLING JOBS ARE
EXAGGERATED TOO OFTEN BY TOO MANY WITH FEW
PROMISES FULFILLED
• QUALITY IS CRITICAL AND YOU NEED TO MAKE YOUR
DECISION TO START THIS CAREER WITH A QUALITY
COMPREHENSIVE EDUCATION
• CREDIBLE TRAINING INVOLVES MANY HOURS OF
INSTRUCTION BY QUALIFIED INSTRUCTORS FOR THERE
IS MUCH TO KNOW
– TRAINING SHOULD INCLUDE MEDICAL BILLING, TERMINOLOGY, AND
HEALTH ADMINISTRATION
MEDICAL CODING CERTIFICATION
• CERTIFIED CODERS ARE HIGHLY VALUED WITH HIGHER SALARIES AND
GOOD JOB SECURITY
• IT IS RECOMMENDED THAT CODERS BE CERTIFIED AS PHYSICIAN CODERS
FIRST AND THEN ADVANCE TO HOSPITAL CODING IF DESIRED
• PHYSICIAN CODING INVOLVES CODING FOR HEALTHCARE PROVIDER
SERVICES WITHIN DOCTOR OFFICES, CLINICS, URGENT CARE AND
EMERGENCY ROOM
• HOSPITAL CODING IS DISTINGUISHED AS OUTPATIENT AND INPATIENT
– OUTPATIENT HOSPITAL CODING IS FOR SERVICES WHEN THE PATIENT
IS NOT ADMITTED TO THE HOSPITAL SUCH AS OUTPATIENT SURGERY
CENTERS
– INPATIENT HOSPITAL CODING IS FOR SERVICES PROVIDED BY THE
HOSPITAL, SUCH AS ROOM AND BOARD, SUPPLIES, NURSING STAFF
LEGITIMATE HEALTH
ADMINISTRATIVE
CERTIFYING AGENCIES
•
AHIMA: AMERICAN HEALTH INFORMATION
MANAGEMENT ASSOCIATION (ahima.org)
• OFFERS CERTIFICATION AS CERTIFIED CODING
SPECIALIST FOR THE PHYSICIAN (CCS-P) AND
CERTIFIED CODING SPECIALIST (CCS) FOR INPATIENT
AND OUTPATIENT HOSPITAL
• OFFERS CODING CERTIFICATION AS AN APPRENTICE
(CCA)
• OFFERS CERTIFICATION AS REGISTERED HEALTH
INFORMATION TECHNICIAN (RHIT) AND
ADMINISTRATORS (RHIA) WHO MANAGE CLINICS AND
HOSPITAL DEPARTMENTS AS WELL AS MANY OTHER
JOBS
• AHIMA HAS BEEN INVOLVED IN MANY HEALTH
ADMINISTRATION PROJECTS WITH MEDICAL AND
GOVERNMENTAL AGENCIES FOR OVER 75 YEARS
LEGITIMATE HEALTH
ADMINISTRATIVE
CERTIFYING AGENCIES
• AAPC: AMERICAN ACADEMY OF
PROFESSIONAL CODERS (aapc.com)
• OFFERS CERTIFICATION AS CERTIFIED
PROFESSIONAL CODER (CPC) AND
CERTIFIED PROFESSIONAL CODER (CPC-H)
FOR OUTPATIENT HOSPITAL CODING
• PROVIDES TRAINING AND CONTINUING
EDUCATION UNITS WITHIN THE CODING
FIELD
ONLINE COMPREHENSIVE
MEDICAL CODING COURSE
• Three Sisters M&E Services offer high quality and
comprehensive training in medical coding
• Derived from 15 years experience teaching, writing,
consulting, and presenting in the health administration
including preparation of students for coding exams
• Experience enhanced by the instructor’s five national
certifications in healthcare administration (RHIT, CCS, CPC-H,
CCS-P & CPC)
• Online courses developed by instructor so no cost for books
• Course consists of 30 packets for ICD-9 and 30 packets for
CPT/HCPCS.
• Cost is $500 per course for a total of $1000 for both courses.
FOR MORE INFORMATION
CONTACT
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