Thursday, March 22, 2012

Code Assignments

Code Assignments

Coders need to assign the ICD-9-CM, CPT, HCPCS codes depends on Facility and Physician Coding guidelines

Facility (Hospital) Coding

Inpatient Coding:

ICD-9-CM Vol. 1 and Vol.2 - Diagnosis
Vol.3 - Procedures

Outpatient/Observation Coding:

ICD-9-CM Vol. 1 and Vol.2 - Diagnosis
CPT - Procedures
HCPCS - Supplies

Physician Coding

Inpatient Coding:

ICD-9-CM Vol.1 and Vol.2 - Diagnosis
CPT - Procedures
HCPCS - Supplies

Outpatient/Observation Coding:

ICD-9-CM Vol.1 and Vol.2 - Diagnosis
CPT - Procedures
HCPCS - Supplies

Wednesday, March 14, 2012

Sample CPC/CPC-H Questions1

Sample/Practice/Free CPC/CPC-H Exam Coding Questions

1. According to the ICD-9 guidelines, how is the postpartum period

a. The postpartum period begins immediately after delivery and continues for
six weeks following delivery

b. The postpartum period includes the last month of pregnancy and up to five
months after delivery

c. The postpartum period is different for each pregnancy

d. The postpartum period begins immediately prior to delivery and continues
for six weeks following delivery

2. Select the correct ICD-9 code for a bilateral femoral hernia with gangrene.

a. 552.02
b. 551.00
c. 551.02
d. 553.02

3. What is the correct supply code for an iris-supported intraocular lens?

a. V2599
b. V2631
c. V2744
d. V2715

4. What modifier best describes a surgery performed on the right foot, fourth digit?

a. T8
b. T4
c. RT
d. F8

5. How is the performance measures numerator for Community-Acquired Bacterial Pneumonia (CAP) defined for code 1026F?

a. All patients with the diagnosis of community-acquired bacterial pneumonia
b. All patients with hydration status assessed
c. All patients assessed for history of co-morbid conditions
d. All patients with an appropriate empiric antibiotic prescribed

6. A 29-year-old patient is given an intramuscular Hepatitis A and Hepatitis B vaccine. Select the appropriate codes to report this service.

a. 90471, 90646, 90747
b. 90467, 90632, 90646
c. 90473, 90636
d. 90471, 90636

7. A patient had a whole-body thyroid carcinoma metastases imaging with uptake completed. Select the appropriate codes to report the professional services.

a. 78015-26, 78003-26
b. 78010, 78020
c. 78028, 78020
d. 78018-26, 78020-26

8. The cisterna chyli is located in which body system?

a. Nervous system
b. Lymphatic system
c. Respiratory system
d. Muscular system

9. A 9-month-old baby boy is diagnosed with shaken infant syndrome with subdural hematoma and retinal hemorrhages. The daycare worker told the emergency department physician that she shook the baby to make him stop crying. Select the appropriate diagnoses codes for this patient.

a. 995.55, E967.7, E967.8
b. 362.81, 995.55, E967.4, E968.7
c. 995.55, 362.81, E968.8, E967.8
d. 362.81, E968.8, E967.8

10. What is Hallermann-Streieff considered?

a. A syndrome
b. A muscle
c. A treatment
d. A bone

11. According to procedure coding, how is “skin traction” defined?

a. Application of a force (distracting or traction force) to a limb segment
through a wire, pin, screw, or clamp attached to the skin only

b. Application of a force (longitudinal) to a limb using felt or strapping applied
directly to the skin only

c. Application applied through force to a limb using felt or strapping applied
directly to the skin only

d. Application applied through force to a long bone using a segment of wire,
pin, screw, or clamp attached to the skin only

12. What is a panniculectomy?

a. Intravenous injection of agent to test vascular flow in flap or graft
b. Incision with opening of deep bone cortex
c. Closure of vesicovaginal fistula
d. Excision of excessive skin and subcutaneous tissue from abdomen
“tummy tuck”

13. What is included with an adjacent tissue transfer or rearrangement?

a. Skin graft necessary to close secondary defect
b. Initial wound recipient side preparation
c. Excision of the benign or malignant lesion
d. Modifier P5 on additional codes reported with this procedure

14. An 84-year-old patient with mild hypertension is undergoing a cataract procedure. Select the appropriate anesthesia code(s) for this patient.

a. 66983, 00144-P4
b. 99100, 66983
c. 00148
d. 00142-P2, 99100

15. Mary was seen in Dr. Jones’ office after scalding her hand with steam from a pot of boiling water. Dr. Jones had seen Mary four years ago before she moved out of state. Today, Dr. Jones documents a detailed history and performs a detailed examination. Medical decision-making is of low complexity. He writes her a prescription for an antibiotic cream and asks her to check with him in one week if the burn is not healing. Select the appropriate code for today’s encounter.

a. 99203
b. 99213
c. 99221
d. 99243

16. Which set of codes would be reported for end-stage renal disease services for home dialysis?

a. 90967 to 90970
b. 90935 to 90937
c. 90951to 90953
d. 90963 to 90966

17. A patient was treated by photodynamic therapy for a lesion on the choroid of her left eye. Select the appropriate procedure code(s) for this procedure.

a. 96567-LT
b. 67101-RT
c. 67221-LT
d. 67221, 67225-50

18. What is the correct code for the supply of a Ganciclovir 4.5 mg, longacting implant?

a. L8606
b. J7310
c. A4650
d. E0783

19. A 20-year-old HIV-positive patient was admitted to a hospital observation bed by his PCP for stomach cramps and diarrhea. After tests were completed, the PCP determined that the stomach cramps and diarrhea were results of staphylococcal food poisoning. Select the appropriate diagnoses codes for this patient.

a. 042, 005.0
b. V08, 005.3
c. 005.0, 042
d. 042, V08, 005.3

20. What is the correct 5th digit sub-classification to describe bacteriological or histological examination not done for tuberculosis?

a. 1
b. 3
c. 5
d. No 5th digit is necessary with this diagnosis code set

Tuesday, March 6, 2012

Purpose of Medical Coding

Purpose of Medical Coding

      Diagnosis codes are used to track diseases and other health conditions, whether they are chronic diseases such as diabetes mellitus and heart disease, to contagious diseases such as norovirus, the flu, and athlete's foot. These diagnosis and procedure codes are used by government health programs, private health insurance companies, workers' compensation carriers and others.

Medical classification systems are used for a variety of applications in medicine, public health and medical informatics, including:

Ø   Statistical analysis of diseases and therapeutic actions
Ø   Reimbursement; e.g., based on diagnosis-related groups (DRG)
Ø   Knowledge-based and decision support systems
Ø      Direct surveillance of epidemic or pandemic outbreaks

Medical Coder’s Job

Medical Coder’s Job:
Coders convert the physicians note into codes that is utilized by the insurance providers in compensating the health care provider.It aids in attaining judgment at a glance.

            Medical coders identify specific diagnoses and medical procedures that were rendered from the patients medical records and translate this information into standardized numeric codes.

Medical Coders Need to Know

Medical Coders Need to Know:
           One really has to know about anatomy, diseases, surgical techniques, medical treatments, and medicationsOne really has to know about Anatomy, diseases, surgical techniques, medical treatments and medications.

            Having to read coronary bypass surgeries and count how many arteries were bypassed, whether autogenous saphenous veins were used, or the mammary, or thoracic artery. Furthermore, was extracorporeal circulation used (heart lung machine)?  Was there prolonged mechanical ventilation after the  procedure?

Basic Skills:
Ø   Computer maintenance
Ø   Word processing
Ø   Keyboarding
Ø   Database maintenance
Ø   Telephone communication
Ø   English and written communications
Ø   Medical terminology
Ø   Anatomy
Ø   Physiology
Ø   Basic Pharmacology

Variety of training programs:
 There are a number of medical coding  training programs available such as
Ø   Simple basic training received on the job
Ø   Home study programs
Ø   Technical school diploma
Ø   2-4 years of college program
Ø   Training via workshops, seminars
Ø  Electronic means – online education course, web based seminars, audio conferences

Types of Medical Coding

Types of Medical Coding:

     We have two types of  Medical coding.

1. Physician Coding: Doing to get reimbursement from Insurance companies and Third Party Payers to Physicians (Doctors)

2. Hospital Coding: Doing to get reimbursement from Insurance companies and Third Party Payers to Hospitals

Physician Coding and Hospital Coding divides into again two types. Those are

Outpatient Coding : Those who perform medical coding for Clinics, Physician offices and

Hospital Emergency rooms. These are typically referred to as "Outpatient Medical Coders". 

Inpatient Coding : Those who perform medical coding in major hospitals. 

These are typically referred to as "Inpatient Medical Coders".

Medical Coding Books

Medical Coding Books:

 The following books are used for Medical Coding to assign codes to patient records.

ICD-9-CM : International Classification of Diseases-9th Revision-Clinical Modification

        It provides codes to classify diseases and wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this system, every health condition can be assigned to a unique  category  and given a code, up to six characters long.

CPT : Current Procedural Terminology
        It is maintained by the American Medical Association(AMA) through the CPT Editorial Pane. The CPT code set describes Medical, Surgical, and Diagnostic services and is designed to communicate uniform information about medical services and procedures and procedures among physician, coders, patients, accreditation organizations, and payers for administrative, financial and analytical purposes. 

HCPCS : Healthcare Common Procedural Coding System

        HCPCS Level II codes are alphanumeric and primarily include non-physician services such as ambulance services and prosthetic devices, and represent items and supplies and non-physician services not covered by CPT-4 codes (Level I). Level II alphanumeric procedure and modifier codes are a single alphabetical letter followed by 4 numeric digits; the first alphabetic letter is in the A to V range. Level II codes are maintained by the US Centers for Medicare and Medicaid Services (CMS). There is some overlap between HCPCS codes and National Drug Code (NDC) codes, with a subset of NDC codes also in HCPCS, and vice-versa. The CMS maintains a crosswalk from NDC to HCPCS in the form of an Excel file.

Medical Coding Format

Medical Coding Format:


ICD-9-CM contains 3 Volumes.

Vol.1 and Vol.2 are used for Diagnostic Purpose

Vol.3 is used for Hospital Procedures

Vol. 1 -           Tabular list
            Vol.2  -           Alphabetical Index
            Vol.3  -           Procedural Coding

Format of ICD-9-CM codes are 

Vol.1 and Vol.2

 Numerical Code:

          Minimum of 3 digits and Maximum of 5 digits with decimal point after 3 digits

          No need of decimal point for 3 digit codes

Format with Examples:

          3 Digit Code:   XXX         (Eg., AIDS - 042)

          4 Digit Code:   XXX.X     (Eg., Cough - 786.2)

          5 Digit Code:   XXX.XX   (Eg., Asthma - 493.90)

Alphanumeric Code:       

V-Codes:   Minimum of 3 digits and Maximum of 5 digits with decimal point after 3 digits, Begin with "V"

Format with Examples:

        3 Digit Code:    VXX        (Eg., HIV + - V08)

        4 Digit Code:    VXX.X    (Eg., History of Breast Cancer - V10.3)

        5 Digit Code:    VXX.XX (Eg., Status post CABG procedure - V45.81)

E-Codes:   Minimum of 4 digits and Maximum of 5 digits with decimal point after 4 digits, Begin with "E"

Format with Examples:

        4 Digit Code:    EXXX        (Eg., Injury occurred at Home - E849.0)

        5 Digit Code:    EXXX.X    (Eg., Fall from Ladder  - E881.0)


Minimum of 3 digits and Maximum of 4 digits with decimal point after 3 digits

Format with Examples:

          3 Digit Code:   XX.X         (Eg., Radical Laryngectomy - 30.4)

          4 Digit Code:   XX.XX      (Eg., Proximal Pancreatectomy – 52.51)


CPT codes are used for Physician services

CPT codes are 5 digit Numerical codes without decimal point

Format with Examples:

          5 Digit Code:   XXXXX         (Eg., Chest X-Ray - 71010)


HCPCS codes are used for Non-Physician services such as Ambulance, Wheel Chairs, Injection and etc..

HCPCS codes are 5 digit Alphanumerical codes without decimal point, begin with Alphabet

 Format with Examples:

          5 Digit Code:   GXXXX         (Eg.,Non-Emergency Transportation, per mile - A0080)

Coding Process

Medical Coding Process

Medical Coding Process at Outsource2india

Let us walk you through our medical coding process:

Current Openings

Medical Coding Current Openings:

Genpact                                    -           1-6yrs, Hyderabad, Delhi, Gurgaon
Apollo                                      -           0-3yrs, Hyderabad
Elico                                       -           0-8yrs, Chennai and Hyderabad
E4E                                         -           0yrs, Chennai
Ajuba                                       -           0-10yrs, Chennai
Visionary                                  -           0yrs , Chennai
Insys                                          -           1-3yrs, Chennai
Gebbs                                        -           0-2yrs, Mumbai
Bob Technologies                   -           4-8yrs, Bangalore
XL Health Corp                       -           0-2yrs, Bangalore
SWOT                                       -            0-3yrs, Bangalore
UHG                                          -            0-5yrs, Hyderabad
Next Step Solutions                -            6-8yrs, Hyderabad
Myriad Cons                          -            1-6yrs, Mumbai
Dell                                        -            0-1yrs, Chennai
Achievers Spot                      -            0-3yrs, Chennai, Trichy, Bangalore
Jeevan Scientifc Tech            -            1-6yrs, Chennai
Mafoi Management               -            0-5yrs, Chennai
Phi Consulting                       -            1-5yrs, Chennai, Hyderabad, Secunderabad
Porteck India                         -            1-2yrs, Noida
Datascribe infotech               -            2-5yrs, Bangalore
DST Worldwide                    -            3-5yrs, Hyderabad
Reliant Global Corp.             -            4-8yrs, Bangalore
Partnezz HR Solutions          -             0-5yrs, Ahmedabad
Aldos                                      -             0-2yrs, Bangalore