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 Certification  Overview  Medical Coding Certification  Certification  Medical Auditing Certification  Medical Compliance Certification  Practice Manager Certification  Locate Exam  Prepare for Exam  Exam Tips  Credential Verification  FAQ   Home > Medical Coding > What is Medical Coding? What is Medical Coding? Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional in a physician’s office, outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS.

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Is Medical Coding the same as Medical Billing? No. While the medical coder and medical biller may be the same person or may work closely together to make sure all invoices are paid properly, the medical coder is primarily responsible for abstracting and assigning the appropriate coding on the claims. In order to accomplish this, the coder checks a variety of sources within the patient’s , (i.e. the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies and other sources) to verify the work that was done. Then the coder must assign CPT® codes, ICD-9 codes and HCPCS codes to both report the procedures that were performed and to provide the medical biller with the information necessary to process a claim for reimbursement by the appropriate insurance agency. There is a great deal of diversity among the numerous claims a medical coder processes on a daily basis. While codes vary a great deal in breadth and specificity, the following article represents what a sample medical coding transaction may look like. Article: What Does a Medical Coder Do? It takes a good deal of education and training to become a skilled medical coder. To begin, coders must have a thorough knowledge of and medical terminology. It is also important to become familiar with different types of insurance plans, regulations, compliance, and the coding community’s three critical resource books: CPT®, HCPCS Level II and ICD-9-CM along with their corresponding codes and guidelines. Using code books the medical coder assigns correct codes to record the service levels for the procedures performed and to account for supplies used to treat the patient during an encounter with the physician. Proper assignment of ICD-9-CM codes corresponds with the physician’s diagnoses and completes the “story” of the patient’s illness or injury. On October 1, 2014 the United States will adopt the latest version of medical codes by updating to ICD-10. Last updated in 1977 the new ICD-10 will increase the number of codes from approximately 13,600 to more than 144,000. Read More: How the Transition from ICD-9 to ICD-10 will Affect Coding and the Medical Community. In addition to assigning ICD-9, CPT®, and HCPCs codes, today’s medical coder may be involved in a wide variety of coding-related activities. The coder may audit and re-file appeals of denied claims. The coder may also educate providers and recommend the appropriate application of federal mandates and compliance that require providers to use specific coding and billing standards through chart audits. He/She may also act as an advocate for the provider and patient in issues of coverage and medical necessity. Starting a career in medical coding opens a number of coding-related jobs like Certified Professional Medical Auditor (CPMA®), Certified Professional Compliance Officer (CPCO™), and Certified Physician Practice Manager (CPPM®).

RELATED ARTICLES:  What Medical Coding Training is Required to Become a Coder?  What Does a Medical Coder Do? What Education and Medical Coding Training is Required to Become a Medical Coder? While many coding professionals have strengthened their career by earning their bachelor’s degrees and master’s degrees, neither is required for a career in medical coding. What is required is a solid understanding of anatomy, physiology and medical terminology. It is also highly recommended for serious coders to complete a medical coding course of study, pass the CPC exam and earn their certification as a Certified Professional Coder, or CPC®. Certified Professional Coders, or CPCs®, are in high demand because employers know that these individuals can perform the job of medical coder with the utmost proficiency. Today more than 126,000 medical professionals are members of AAPC. This professional association provides a variety of opportunities to elevate the standards of medical coding by developing training, professional certification, opportunities to network with other related medical professionals and a variety of job search database and career building opportunities. Learn more about AAPC and take advantage of the workshops, on-demand webinars, regional and national conferences, and the monthly magazine, Coding Edge to develop your skills and stand out in your field. As a member of AAPC you will also be able to meet other coding professionals by participating in the coding discussion forums, Facebook group, or one of more than 550 local chapters throughout the United States and outlying areas. AAPC members also enjoy huge savings on medical coding books as well as a variety of other members-only exclusive discounts. Since its inception more than 20 years ago AAPC has developed a wide variety of professional credentials allowing its members to stand out amongst their peers and validate their expertise in a variety of fields. Coders may choose to broaden their skills by extending into medical auditing, compliance, out-patient practice, or practice management. Others may choose to complete a medical coding training course or specialize by earning one of AAPC’s specialty credentials. The AAPC credential is recognized nationally by employers, medical societies and government organizations. They are a great way to start a career in medical coding and the recent medical coding salary survey suggests that AAPC certified coders earn significantly more than non- credentialed coders. Where Do I Begin? If you are interested about what you have read so far about AAPC and opportunities pursuing medical coding, medical auditing, practice management, compliance, or one of the other specialized credentials you can start your new career by joining AAPC or by registering for one of the medical coding training courses today. USEFUL CODING LINKS: Medical Coding Career Survey – Discount Coding Books – Medical Coding Training and Education – Medical Coding Certifications – Certified Professional Coder (CPC®) – Coding Specialties – Online Forum – Medical Terminology and Coding Glossary – Find Coding Jobs in Your Area From Wikipedia, the free encyclopedia

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Medical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers. The diagnoses and procedures are usually taken from a variety of sources within the health care record, such as the transcription of the physician's notes, laboratory results, radiologic results, and other sources. 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 companies, workers' compensation carriers and others. Medical classification systems are used for a variety of applications in , and medical informatics, including:  statistical analysis of diseases and therapeutic actions  reimbursement; e.g., based on diagnosis-related groups  knowledge-based and decision support systems  direct surveillance of epidemic or pandemic outbreaks Contents  1 Classification types  2 WHO Family of International Classifications o 2.1 Reference classifications o 2.2 Derived classifications o 2.3 Related classifications  3 Other medical classifications o 3.1 Diagnosis o 3.2 Procedure o 3.3 Other . 3.3.1 Library classification that have medical components  4 ICD, SNOMED and (EHR) o 4.1 What is SNOMED? o 4.2 What is ICD? o 4.3 SNOMED CT vs ICD o 4.4 Data Mapping of SNOMED and ICD  5 Clinical Coding in Australia o 5.1 What is clinical coding? o 5.2 What does do? o 5.3 What is coded data used for?  6 See also  7 References  8 External links Classification types Many different medical classifications exist, though they occur into two main groupings: Statistical classifications and Nomenclatures. A statistical classification brings together similar clinical concepts and groups them into categories. The number of categories is limited so that the classification does not become too big. An example of this is the International Statistical Classification of Diseases and Related Health Problems (known as ICD). It groups diseases of the circulatory system into one "chapter" (known as Chapter IX, covering codes I00–I99). Within this chapter, there is for instance, code I47.1. The code title (rubric) is Supraventricular tachycardia. However, there are several other clinical concepts that are also classified here. Among them are paroxysmal atrial tachycardia, paroxysmal junctional tachycardia, auricular tachycardia and nodal tachycardia. Another feature of statistical classifications is the provision of residual categories for "other" and "unspecified" conditions that do not have a specific category in the particular classification. In a nomenclature there is a separate listing and code for every clinical concept. So, in the previous example, each of the tachycardia listed would have its own code. This makes nomenclatures unwieldy for compiling health statistics. Types of coding systems specific to health care include:  Diagnostic codes - Are used to determine diseases,disorders, and Symptoms -Can be used to measure morbidity and mortality Examples: ICD-9-CM, ICD-10  Procedural codes -They are numbers or alphanumeric codes used to identify specific health interventions taken by medical professionals. Examples: ICPM, ICHI  Pharmaceutical codes -Are used to identify medications Examples: AT, NDC  Topographical codes -Are codes that indicate a specific location in the body Examples :ICD-O, SNOMED WHO Family of International Classifications The World Health Organization (WHO) maintains several internationally endorsed classifications designed to facilitate the comparison of health related data within and across populations and over time as well as the compilation of nationally consistent data.[1] This "Family of International Classifications" (FIC) include three main (or reference) classifications on basic parameters of health prepared by the organization and approved by the World Health Assembly for international use, as well as a number of derived and related classifications providing additional details. Some of these international standards have been revised and adapted by countries for national use. Reference classifications  International Statistical Classification of Diseases and Related Health Problems (ICD)[2] o ICD-9 (9th revision, published in 1977) . ICD-9-CM (Clinical Modification, used in the US) o ICD-10 (10th revision, in use by WHO since 1994) . ICD-10-CM (Clinical Modification, used in the US) . ICD-10-PCS (Procedure Coding System, used in the US) . ICD-10-CA (used for morbidity classification in Canada).[3] . ICD-10-AM (used in Australia and New Zealand)[4] . EUROCAT - an extension of the ICD-10 Q chapter for congenital disorders  International Classification of Functioning, Disability and Health (ICF)  International Classification of Health Interventions (ICHI) (previously known as International Classification of Procedures in Medicine)[5] Derived classifications Derived classifications are based on the WHO reference classifications (i.e. ICD and ICF).[1] They include:  International Classification of Diseases for , Third Edition (ICD-O-3)  ICD-10 for Mental and Behavioural Disorders[6]  Application of the International Classification of Diseases to and Stomatology, 3rd Edition (ICD-DA)[7]  Application of the International Classification of Diseases to (ICD-10-NA)[8] Related classifications Related classifications in the WHO-FIC are those that partially refer to the reference classifications, e.g. only at specific levels.[1] They include:  International Classification of Primary Care (ICPC)[9] o ICPC-2 PLUS  International Classification of External Causes of Injury (ICECI)[10]  Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC/DDD)  Technical aids for persons with disabilities: Classification and terminology (ISO9999)[11]  International Classification for Nursing Practice (ICNP)[12] Other medical classifications Diagnosis The categories in a diagnosis classification classify [ and medical signs. In addition to the ICD and its national variants, they include:  Diagnostic and Statistical Manual of Mental Disorders (DSM) o DSM-IV Codes  International Classification of Headache Disorders 2nd Edition (ICHD-II)[13]  International Classification of Sleep Disorders (ICSD)  Online Mendelian Inheritance in Man , database of genetic codes  Read codes  Systematized Nomenclature of Medicine - Clinical Terms (SNoMed-CT) Procedure The categories in a procedure classification classify specific health interventions undertaken by health professionals. In addition to the ICHI and ICPC, they include:  Australian Classification of Health Interventions (ACHI)  Canadian Classification of Health Interventions (CCI) [14]  Chinese Classification of Heath Interventions (CCHI)  Current Procedural Terminology (CPT)  Health Care Procedure Coding System (HCPCS)  ICD-10 Procedure Coding System (ICD-10-PCS)  Office of Population, Censuses and Surveys Classification of Surgical Operations and Procedures (OPCS-4) Other  Classification of Pharmaco-Therapeutic Referrals (CPR)  Logical Observation Identifiers Names and Codes (LOINC), standard for identifying medical laboratory observations  Medical Dictionary for Regulatory Activities (MedDRA)  Medical Subject Headings (MeSH) o List of MeSH codes  Nursing Interventions Classification (NIC)  Nursing Outcomes Classification (NOC)  TIME-ITEM , ontology of topics in medical education  TNM Classification of Malignant Tumors  Unified Medical Language System (UMLS)  Victoria Ambulatory Coding System (VACS) / Queensland Ambulatory Coding System (QACS), Australia[citation needed]

Library classification that have medical components  Dewey Decimal System and Universal Decimal Classification (section 610–620)  National Library of Medicine classification ICD, SNOMED and Electronic Health Record (EHR) What is SNOMED? The Systematized Nomenclature of Medicine (SNOMED) is the most widely recognised nomenclature in healthcare.[15] Its current version, SNOMED Clinical Terms (SNOMED CT), is intended to provide a set of concepts and relationships that offers a common reference point for comparison and aggregation of data about the health care process.[16] SNOMED CT is often described as a reference terminology.[17] SNOMED CT contains more than 311,000 active concepts with unique meanings and formal logic-based definitions organised into hierarchies.[16] SNOMED CT can be used by anyone with an Affiliate License, 40 low income countries defined by the World Bank or qualifying research, humanitarian and charitable projects.[16] SNOMED-CT is designed to be managed by computer, and it is a complex relationship concepts.[15] What is ICD? The International Classification of Disease (ICD) is the most widely recognized medical classification maintained by the World Health Organization (WHO).[18] Its primary purpose is to categorise diseases for morbidity and mortality reporting. The United States has used a clinical modification of ICD (ICD-9-CM) for the additional purposes of reimbursement. ICD-10 was endorsed by WHO in 1990, and WHO Member states began using the classification system in 1994 for both morbidity and mortality reporting. In the US, however, it has only been used for reporting mortality since 1999. Because of the US delay in adopting its version of ICD-10, it is currently unable to compare morbidity data with the rest of the world. ICD has a hierarchical structure, and coding in this context, is the term applied when representations are assigned to the words they represent.[18] Coding diagnoses and procedures is the assignment of codes from a code set that follows the rules of the underlying classification or other coding guidelines. SNOMED CT vs ICD SNOMED CT and ICD are designed for different purposes and each should each be used for the purposes for which it was designed.[19] As a core terminology for the EHR, SNOMED CT provides a common language that enables a consistent language that enables a consistent way of capturing, sharing, and aggregating health data across specialties and sites of care.[20] It is highly detailed terminology designed for input not reporting. Classification systems such as ICD-9-CM, ICD-10-CM, and ICD-10-PCS group together similar diseases and procedures and organise related entities for easy retrieval.[20] They are typically used for external reporting requirements or other uses where data aggregation is advantageous, such as measuring the quality of care monitoring resource utilisation, or processing claims for reimbursement. SNOMED is clinically- based, document whatever is needed for patient care and has better clinical coverage than ICD. ICD’s focus is statistical with less common diseases get lumped together in “catch-all” categories, which result in loss of information. SNOMED CT is used directly by healthcare providers during the process of care, whereas ICD is used by coding professionals after the episode of care. SNOMED CT had multiple hierarchy, whereas single hierarchy for ICD. SNOMED CT concepts are defined logically by their attributes, whereas only textual rules and definitions in ICD.[20] Data Mapping of SNOMED and ICD SNOMED and ICD can be coordinated. The National Library of Medicine (NLM) maps ICD-9- CM, ICD-10-CM, ICD-10-PCS, and other classification systems to SNOMED.[21] Data Mapping is the process of identifying relationships between two distinct data models. The full value of the health information contained in an EHR system will only be realised if both systems involved in the map are up to date and accurately reflect the current practice of medicine.[18] Clinical Coding in Australia Medical coding and classification systems are expected to become increasingly important in the health care sector. Together with and as an integrated part of the electronic health information systems, the coding and classification systems will be used to improve the quality and effectiveness of the medical services.[22] What is clinical coding? Clinical coding is the translation of written, scanned and/or electronic clinical documentation about patient care into code format. For example, hypertension is represented by the code 'I10'; general anaethesia is represented by the code'92514-XX[1910]'. A standardised classification system, The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), is applied in all Australian acute health facilities. It is based on the World Health Organisation (WHO) ICD-10 system, updated with the Australian Classification of Health Interventions (ACHI), Australian Coding Standards (ACS). Clinical coding is a specialised skill requiring excellent knowledge of medical terminology and disease processes, attention to detail, and analytical skills.[23] What does clinical coder do? A clinical coder is responsible for abstracting relevant information from the medical record and deciding which diagnoses and procedures meet criteria for coding as per Australian and State Coding Standards. The coder then assigns codes for these diagnoses and procedures based on ICD-10-AM conventions and standards.[23] What is coded data used for? The assigned codes and other patient data are processed by grouper software to determine a Diagnosis Related Group (DRG) for the episode of care, which is used for funding and reimbursement. This process allows hospital episodes to be grouped into meaningful categories, helping us to better match patient needs to health care resources.[24]