Medical Coding and Billing Specialist
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Medical Coding and Billing Specialist Instruction Pack 3 Lessons 21-30 ® Explore the possibilities ® 0205502LB03A-13 Medical Coding and Billing Specialist Instruction Pack 3 Lesson 21—Solving Problems with Insurance Carriers, Providers and Patients Lesson 22—Coding and Billing Resources Lesson 23—ICD-9-CM Coding Introduction Lesson 24—ICD-9-CM Coding—From Infections to Blood Diseases Lesson 25—ICD-9-CM Coding—From Mental Disorders to Circulatory System Lesson 26—ICD-9-CM Coding—From Respiratory System to Complications of Pregnancy Lesson 27 —ICD-9-CM Coding—From Diseases of the Skin to Conditions in the Perinatal Period Lesson 28—ICD-9-CM Coding—From Symptoms to Complications Lesson 29—V Codes, E Codes and ICD-9-CM Coding Practicum Lesson 30—The Future of Health Care Medical Coding and Billing Specialist No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, for any purpose, without the express written permission of U.S. Career Institute. Copyright © 2012-2013, Weston Distance Learning, Inc. All Rights Reserved. 0205502LB03A-13 Acknowledgments Author Katy Little Editorial Staff Trish Bowen Katy Little Leslie Ballentine Elizabeth Munson Bridget Tisthammer Kathy DeVault Georgia Chaney Brenda Blomberg Stephanie MacLeod Chris Jones Sue Bentley Carrie Williams Joyce Jeckewicz Jessica Tuttle Design/Layout Connie Hunsader Sandy Petersen D. Brent Hauseman FOR MORE INFORMATION CONTACT: U.S. Career Institute Fort Collins, CO 80525 • 1-800-347-7899 www.uscareerinstitute.edu 0205502LB03A-13 Table of Contents Table of Contents Lesson 21—Solving Problems with Insurance Carriers, Providers and Patients Step 1 Learning Objectives for Lesson 21 ...........................................................1 Step 2 Lesson Preview ..........................................................................................1 Step 3 Dealing With Insurance Problems ...........................................................2 Step 4 Following Through on Insurance Problems .............................................3 Resubmitting a Paper Claim ....................................................................3 Resubmitting an Electronic Claim ...........................................................5 Sending a Tracer .......................................................................................5 Filing a Narrative Explanation ................................................................7 Appeals ...................................................................................................... 8 The Insurance Commissioner .................................................................10 Rejected Versus Denied Claims ............................................................. 10 Step 5 Practice Exercise 21-1 .............................................................................11 Step 6 Review Practice Exercise 21-1 ................................................................11 Step 7 Billing Patients ....................................................................................... 11 Step 8 Credit .......................................................................................................12 Your Credit Report ..................................................................................13 Step 9 Delinquent Accounts ...............................................................................15 Handling Returned Checks .................................................................... 15 Handling Nonpayment ........................................................................... 16 Step 10 Collection Agencies ................................................................................. 18 Using Collection Agencies ...................................................................... 18 Step 11 Small Claims Court ................................................................................ 19 Filing a Claim ..........................................................................................19 Collecting a Judgment ............................................................................ 20 Step 12 Solving Patient Problems ....................................................................... 20 Step 13 Solving Problems With Providers .......................................................... 22 Step 14 Professional Liability Insurance ............................................................ 22 Step 15 How Does Compliance Affect Medical Coders and Billers? ..................23 Elements of Compliance ......................................................................... 23 Step 16 Practice Exercise 21-2 .............................................................................25 Step 17 Review Practice Exercise 21-2 ................................................................26 Step 18 Lesson Summary .....................................................................................26 Business Forms for a Medical Coding and Billing Specialist ...............27 Step 19 Mail-in Quiz 21 ....................................................................................... 40 Mail-in Quiz 21 ....................................................................................... 40 0205502LB03A-13 i Medical Coding and Billing Specialist Lesson 22—Coding and Billing Resources Step 1 Learning Objectives for Lesson 22 ...........................................................1 Step 2 Lesson Preview ..........................................................................................1 Step 3 Associations for Professional Coders and Billers .................................... 2 Step 4 Credentialing .............................................................................................5 Step 5 Practice Exercise 22-1 ...............................................................................8 Step 6 Review Practice Exercise 22-1 ..................................................................9 Step 7 Coding and Billing Resources ...................................................................9 Step 8 Practice Exercise 22-2 .............................................................................15 Step 9 Review Practice Exercise 22-2 ................................................................15 Step 10 Lesson Summary .....................................................................................15 Step 11 Mail-in Quiz 22 ....................................................................................... 16 Mail-in Quiz 22 ....................................................................................... 16 Endnotes .................................................................................................. 19 Lesson 23—ICD-9-CM Coding Introduction Step 1 Learning Objectives for Lesson 23 ...........................................................1 Step 2 Lesson Preview ..........................................................................................1 Step 3 History of the International Classifi cation of Diseases .......................... 2 The WHO ...................................................................................................3 ICD-9-CM .................................................................................................. 3 Step 4 Why Code? ................................................................................................. 4 Step 5 ICD-10 ....................................................................................................... 5 Impact for Coders ......................................................................................6 Step 6 ICD-9-CM vs. ICD-10-CM ........................................................................ 6 Step 7 Practice Exercise 23-1 ...............................................................................7 Step 8 Review Practice Exercise 23-1 ..................................................................8 Step 9 Organization of Volume 2, Alphabetic Index to Diseases ICD-9-CM...... 8 Main Terms ............................................................................................. 9 Subterms ................................................................................................. 10 Step 10 Organization of Volume 1, Tabular List ................................................ 12 Step 11 Practice Exercise 23-2 .............................................................................15 Step 12 Review Practice Exercise 23-2 ................................................................16 Step 13 Introduction to Coding Guidelines .........................................................16 Cross-reference Terms ...........................................................................18 Step 14 Practice Exercise 23-3 .............................................................................28 Step 15 Review Practice Exercise 23-3 ................................................................29 Step 16 ICD-9-CM Terminology .......................................................................... 29 ii 0205502LB03A-13 Table of Contents Step 17 The Appendices ....................................................................................... 31 Appendix A—Morphology of Neoplasms ................................................31 Appendix B—Glossary of Mental Disorders ..........................................31 Appendix C—Classifi cation of Drugs by AHFS List .............................31 Appendix D—Industrial Accidents According