CPT Procedural Codes

Words: 991
Pages: 4
Open Document
Week 1 Discussion Thread
Part 1: Discuss the necessity of understanding the interaction of the CPT procedural codes and the ICD diagnostic codes.

In order to understand the interaction of the CPT procedural codes and ICD diagnostic codes it is important to know the function for individual codes.

CPT procedural codes a series of numbers, usually five digits long. They are used to identify medical services and procedures performed by physicians as well as for other diagnostic services. They are a language of communication with third party insurance payers.

ICD codes are codes used in assigning a number to describe thousands of possible diseases, as well as traumatic, social and environmental circumstances leading to bodily harm.

Part …show more content…
Report all healthcare data elements (e.g. diagnosis and procedure codes, present on admission indicator, discharge status) required for external reporting purposes (e.g. reimbursement and other administrative uses, population health, quality and patient safety measurement, and research) completely and accurately, in accordance with regulatory and documentation standards and requirements and applicable official coding conventions, rules, and guidelines.
3. Assign and report only the codes and data that are clearly and consistently supported by health record documentation in accordance with applicable code set and abstraction conventions, rules, and guidelines.
4. Query provider (physician or other qualified healthcare practitioner) for clarification and additional documentation prior to code assignment when there is conflicting, incomplete, or ambiguous information in the health record regarding a significant reportable condition or procedure or other reportable data element dependent on health record documentation (e.g. present on admission indicator).
5. Refuse to change reported codes or the narratives of codes so that meanings are …show more content…
Demonstrate behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities.
(AHIMA Standards of Ethical Coding. (n.d.). Retrieved from http://bok.ahima.org/doc?oid=106344#.WG7mVxsrLIU)

Unethical Coding Practice:

1. Query the provider when there is no clinical information in the health record prompting the need for a query. Example:
Query the provider regarding the presence of gram-negative pneumonia on every pneumonia case, regardless of whether there are any clinical indications of gram-negative pneumonia documented in the record.

2. Refuse to change reported codes or the narratives of codes so that meanings are misrepresented.
Coding professionals shall not:
Change the description for a diagnosis or procedure code or other reported data element so that it does not accurately reflect the official definition of that code.
Example:
The description of a code is altered in the encoding software, resulting in incorrect reporting of this code.
3. Refuse to participate in or support coding or documentation practices intended to inappropriately increase payment, qualify for insurance policy coverage, or skew data by means that do not comply with federal and state statutes, regulations and official rules and
Show More

Related Documents: CPT Procedural Codes

Billing and Coding Essay

The Use of Medical Code Sets Adrianna Lopez Charter College Abstract Medical coding is a specialized profession within the wider field of healthcare administration. Medical coders review the documents within a patient’s medical records. They will then translate the written documentation into medical codes that are used throughout the medical field. These codes are used to submit claims to third party payers, and to gather information by keeping track of incidents of specific diseases. Accurate…

Words 915 - Pages 4

Summary: Influenza and Breast Localization Device Essay

Summary For 2014, the four new codes (99446-99449) for interprofessional telephone/Internet assessment and management services have been added to the E/M section. Use these codes without the need for face-to-face contact with the consultant. Code 99446 is defined as an interprofessional telephone/Internet assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional…

Words 1308 - Pages 6

Barriers In Healthcare

reimbursement from Medicare is a three step process: appropriate coding of the service provided by utilizing current procedural terminology, appropriate coding of diagnosis using ICD-9 code and, the Centers for Medicare and Medicaid Services determination of the appropriate fee based on the resources-based relative value scale. CPT, is a proprietary product of the American Medical Association. CPT is a uniform coding system that was developed in conjunction between physicians and the Health Care Financing…

Words 858 - Pages 4

Essay about How to Adjust Polar Orifices

MPH I n the 2011 Current Procedural Terminology ( CPT) * h andbook, the subsection heading “Excision and Debridement” has been revised to refer only to “Debridement.” As a result, codes have been deleted, and new debridement codes have been added. Additionally, the active wound care management and debridement of open fracture codes have been revised to correspond with current clinical practice. Debridement is a common procedure appearing throughout the CPT book. It is often used to remove…

Words 1833 - Pages 8

Clinical IT And Financial IT

Abbreviations The first abbreviation is CPT. CPT stands for Current Procedural Terminology. This coding system was developed by the American Medical Association. The system was setup as a system to correlate a patient’s diagnosis codes and codes that insurance companies use in order to pay for the services that providers provide (CPT, 2009). Each CPT code represents a particular service charged by the physician to the insurance provider. These codes are sent to insurance companies from billing…

Words 1302 - Pages 6

Healthcare Insurance Financial Statement

deductible has been met. 11. Co-payment Specified amount the insured must pay toward the charge for professional services rendered at the time of services. 12. Current procedural terminology (CPT) Consists of six sections. Level II National codes are used to report supplies and services for which there are no current CPT codes. 13. Deductible A predetermined amount the insured must pay each year before the insurance company will pay for an accident or illness. 14. Effective date The date when…

Words 929 - Pages 4

Course Notes Essay

hospitalists and will treat the patient during the hospital stay. Answer the Following Questions: 1. Q) If a technician in a lab withdraws blood by means of a venipuncture, is that coded? If yes, with what code? ANSWER: Yes, 36415 2. Q) Can a modifier -52 be reported with a panel code to indicate one of the tests was not performed? Explain. ANSWER: No, you would instead list each of the tests seperately 3. Q) What type of test is performed to help a physician monitor the level of medication…

Words 892 - Pages 4

HSA 515 Dealing with Fraud Essay

Dealing with Fraud Demetrice Armwood Dr. James Coon, Jr HSA 515 Health Care Policy, Law, and Ethics June 16, 2013 As the Chief Nursing Officer of the state’s largest Obstetric Health Care Center, this author is responsible for complaints regarding fraudulent behavior in the center. The purpose of this report is to (1) evaluate how the Healthcare Qui tam affects health care organizations, (2) provide four examples of Qui Tam cases that exist in a variety…

Words 1967 - Pages 8