
Ingenix Coding Lab 2 : Physician Offices 2003
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Summary
Table of Contents
Introduction | p. 1 |
Welcome to Ingenix Coding Lab: Physician Offices, an advanced training program for medical coders | p. 1 |
Medical Coders as Professionals | p. 1 |
Certification | p. 2 |
Organizations | p. 4 |
Medical Coding in the Physician Office Setting | p. 5 |
Introduction | p. 5 |
The Practice of Medicine | p. 5 |
Medical Specialties | p. 6 |
Subspecialties | p. 7 |
Specialty Organizations | p. 8 |
Specialty Coding | p. 8 |
Discussion Questions | p. 9 |
CPT Coding | p. 11 |
Introduction | p. 11 |
Level I: CPT | p. 11 |
CPT 5 Project | p. 12 |
Importance of Current Codes | p. 13 |
Structure of CPT | p. 15 |
Guidelines | p. 17 |
General Guidelines for Using CPT | p. 17 |
Putting CPT to Work | p. 31 |
The 10 Steps to Basic CPT Coding | p. 34 |
Evaluation and Management Services (99201-99499) | p. 35 |
Components of E/M Services | p. 42 |
Documentation Guidelines of Key Components for Evaluation and Management Services | p. 44 |
Demonstration of E/M Level Selection | p. 71 |
Documentation of an Encounter Dominated by Counseling or Coordination of Care | p. 72 |
Anesthesia (00100-01999) | p. 72 |
Section Guidelines | p. 74 |
Surgery (10021-69999) | p. 80 |
General (10021-10022) | p. 88 |
Integumentary System (10040-19499) | p. 89 |
Repairs and Closures | p. 91 |
Musculoskeletal System (20000-29909) | p. 97 |
Respiratory System (30000-32999) | p. 107 |
Cardiovascular System (33010-37799) | p. 110 |
Hemic and Lymphatic System (38100-38999) | p. 121 |
Mediastinum and Diaphragm (39000-39599) | p. 122 |
Digestive System (40490-49999) | p. 122 |
Urinary System (50010-53899) | p. 129 |
Male Genital System (54000-55899) | p. 132 |
Female Genital System (56405-58999) | p. 134 |
Maternity Care and Delivery (59000-59899) | p. 138 |
Endocrine System (60000-60699) | p. 140 |
Nervous System (61000-64999) | p. 141 |
Eye and Ocular Adnexa (65091-68899) | p. 146 |
Auditory System (69000-69979) | p. 150 |
Radiology Section (70010-79999) | p. 154 |
Pathology and Laboratory Section (80048-89339) | p. 156 |
Medicine Section (90281-99199) | p. 160 |
Summary | p. 169 |
Discussion Questions | p. 169 |
ICD-9 | p. 171 |
Introduction | p. 171 |
Alphabetic Index to Diseases and Injuries | p. 172 |
Table of Drugs and Chemicals | p. 172 |
Alphabetic Index to External Causes of Injury and Poisoning (E Codes) | p. 172 |
ICD-9-CM Conventions | p. 178 |
Putting ICD-9-CM to Work | p. 185 |
Coding Guidelines | p. 185 |
Clinical Applications | p. 186 |
Infectious and Parasitic Diseases (Categories 001-139) | p. 189 |
Neoplasms (Categories 140-239) | p. 195 |
Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders (Categories 240-279) | p. 200 |
Diseases of the Blood and Blood-forming Organs Categories (280-289) | p. 207 |
Mental Disorders (Categories 290-319) | p. 210 |
Mental Disorders Specific to Childhood and Adolescence (313-316) | p. 215 |
Nervous System and Sense Organs (Categories 320-389) | p. 215 |
Inflammatory Diseases of the Central Nervous System (320-326) | p. 216 |
Hereditary and Degenerative Diseases of the Central Nervous System (330-337) | p. 217 |
Disorders of the Autonomic Nervous System (337) | p. 218 |
Other Disorders of the Central Nervous System (340-349) | p. 218 |
Disorders of the Peripheral Nervous System (350-359) | p. 219 |
Circulatory System (Categories 390-459) | p. 220 |
Ischemic Heart Disease (410-414) | p. 225 |
Cerebrovasular Disease (430-438) | p. 227 |
Diseases of Arteries, Arterioles and Capillaries (440-448) | p. 228 |
Diseases of the Veins and Lymphatics and Other Diseases of Circulatory System (451-459) | p. 229 |
Respiratory System (Categories 460-519)) | p. 230 |
Other Diseases of the Upper Respiratory Tract (470-478) | p. 232 |
Digestive System Categories (520-579) | p. 235 |
Other Diseases of Intestines and Peritoneum (560-569) | p. 238 |
Genitourinary System (Categories 580-629) | p. 241 |
Diseases of Male Genital Organs (600-608) | p. 243 |
Pregnancy, Childbirth, and Puerperium (Categories 630-677) | p. 244 |
Skin and Subcutaneous Tissue (Categories 680-709) | p. 247 |
Infections of the Skin and Subcutaneous Tissue (680-686) | p. 247 |
Musculoskeletal System and Connective Tissue (Categories 710-739) | p. 249 |
Congenital Anomalies (Categories 740-759) | p. 254 |
Congenital Anomalies (740-759) | p. 254 |
Conditions in the Perinatal Period (Categories 760-779) | p. 255 |
Symptoms, Signs, and Ill-defined Conditions (Categories 780-799) | p. 256 |
Injury and Poisoning (Categories 800-999) | p. 258 |
Supplementary Classifications (Categories V01-V83, E800-E999) | p. 264 |
Persons Encountering Health Services in Other Circumstances (V60-V68) | p. 267 |
E Codes | p. 270 |
Discussion Questions | p. 271 |
ICD-10 | p. 273 |
Introduction | p. 273 |
ICD-10-CM Structure | p. 274 |
Summary | p. 277 |
HCPCS | p. 279 |
Introduction | p. 279 |
HCPCS Level I/CPT | p. 279 |
HCPCS Level II/National Codes | p. 279 |
HCPCS Level III/Local Codes | p. 280 |
The HCPCS National Codes in Detail | p. 280 |
HCPCS Codes | p. 280 |
Use of HCPCS | p. 282 |
How to Use HCPCS | p. 282 |
Modifiers | p. 283 |
Unlisted HCPCS Codes | p. 285 |
The DMEPOS Industry | p. 285 |
Managed Care and DMEPOS | p. 285 |
Defining DME | p. 286 |
Defining Prostheses | p. 288 |
Defining Orthoses | p. 288 |
Defining Supplies | p. 289 |
DMEPOS and Third-party Payers | p. 290 |
Special DMEPOS Coverage | p. 290 |
Documentation and Certificates of Medical Necessity | p. 291 |
Certificates of Medical Necessity | p. 293 |
Other Third-party Payers | p. 295 |
Provider Orders for DMEPOS | p. 296 |
Orders Contained in the Clinical Record | p. 296 |
DMEPOS Supplier Registration | p. 296 |
Non-Par Limits on Charges | p. 297 |
The National Supplier Clearinghouse | p. 297 |
The DMERCs | p. 297 |
SADMERC | p. 297 |
Other Coding Systems | p. 298 |
Discussion Questions | p. 298 |
Practice Issues That Affect Medical Coding | p. 299 |
Introduction | p. 299 |
History of Medical Record Documentation | p. 299 |
Documentation Overview | p. 301 |
General Guidelines for Documentation | p. 302 |
Principles of Documentation | p. 302 |
Documentation to Code and Bill | p. 303 |
Fraud and Abuse | p. 305 |
Using the Record | p. 307 |
Summary | p. 309 |
Discussion Questions | p. 309 |
HIPAA | p. 311 |
Introduction | p. 311 |
Privacy in Health Care | p. 311 |
Transactions and Code Sets | p. 313 |
Security | p. 315 |
HIPAA Definitions | p. 315 |
Summary | p. 319 |
Discussion Questions | p. 319 |
The Insurance Process--Private and Public | p. 321 |
Introduction | p. 321 |
History | p. 321 |
Medicare and Medicaid | p. 321 |
Health Insurance Today | p. 322 |
Payer Comparisons | p. 322 |
The Reimbursement Process | p. 326 |
The Claim Form | p. 328 |
Common terms | p. 329 |
Insurance Fraud and Abuse | p. 329 |
Summary | p. 331 |
Discussion Points | p. 331 |
Relative Values and Fee Schedules | p. 333 |
Introduction | p. 333 |
The UCR System | p. 334 |
Fee Schedules and RVUs | p. 334 |
Setting Fees for a Practice | p. 338 |
Summary | p. 340 |
Discussion Points | p. 340 |
Glossary | p. 341 |
Insurance Commissioners | p. 473 |
Valid Three-Digit ICD-9-CM Codes | p. 477 |
Sample Modifier Flow Chart | p. 479 |
Index | p. 481 |
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