procedurediagnosis code overview. participants will interpret basic medical codes and assess how to...
TRANSCRIPT
PROCEDURE DIAGNOSIS
CODE OVERVIEW
Participants will interpret basic medical codes and assess how to use them when conducting provider fraud investigations.
Learning Objective
Medical coding is a uniform language that allows a reliable means of communication among physicians, patients and third parties.
Medical “Code Speak”
ICD means International Statistical Classifications of Diseases.
ICD codes are alphanumeric designations given to every diagnosis, description of symptoms and cause of death attributed to human beings.
ICD-9 and ICD-10 Codes.
The Diagnosis
HCPCS Codes
Healthcare Common Procedure Coding System (HCPCS) is maintained by the Centers for Medicare and Medicaid Services (CMS).
Provide a system for reporting the medical services provided to Medicare beneficiaries.
HCPCS Code RangesA-codes: Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental
B-codes: Enteral and Parenteral Therapy
C-codes: Temporary Hospital Outpatient Prospective Payment System
D-codes: Dental Procedures
E-codes: Durable Medical Equipment
G-codes: Temporary Procedures & Professional Services
H-codes: Rehabilitative Services
J-codes: Drugs Administered Other Than Oral Method, Chemotherapy Drugs
K-codes: Temporary Codes for Durable Medical Equipment Regional Carriers
L-codes: Orthotic/Prosthetic Procedures
M-codes: Medical Services
P-codes: Pathology and Laboratory
Q-codes: Temporary Codes
R-codes: Diagnostic Radiology Services
S-codes: Private Payer Codes
T-codes: State Medicaid Agency Codes
V-codes: Vision/Hearing Services
CPT codes enable healthcare providers to effectively and efficiently communicate with government or private insurance companies about medical, surgical and diagnostic services rendered to a patient.
The CPT Coding System
The Current Procedural Terminology (CPT) is a five digit coding system first published by the American Medical Association (AMA) in 1996.
The Procedure / Service
1
ToFrom
Medicine90281 9699997001 9779998925 99199
Surgery 10021 69999
Radiology 70010 79999
Pathology 80002 89399
Evaluation & Management 99201 99499
Hospital DRG Code DRG-001 DRG-999
Anesthesia 00100 0199999100 99142
CPT Code Ranges
Health InsuranceClaim Form 1500
Claim Form 1500Page 2
Medical Record Documentation
Cycle
DOL/OWCP Review Claim
Documents are Coded &
Submitted to DOL/OWCP
Doctor Examines Claimant
Doctor Renders
Treatment & Documents Diagnosis
Claimant Goes to Doctor
PaymentSent
Most provider offices use
“superbills” for billing purposes.