ICD-10 Review
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MAS 107
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Dec 6, 2023
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ICD 10 Review
CD-10-CM Review
1. Describe the history of the International Classification of Disease coding system.
The ICD coding system was
developed by the World Health Organization in 1948 to collect more accurate statistics about incidence and
treatment of disease, but after 1989 it became the system of choice for diagnostic coding on insurance claims, when
the Health Care Financing Administration began requiring its use for Medicare Part B insurance claims.
2. What are several new features of ICD-10-CM codes compared with ICD-9-CM codes?
The several new features
of ICD-10-CM codes contain are more extensive information related to ambulatory care, an expansion of injury
codes, more combination codes, added sixth and seventh digits for some codes, and an increased ability to choose
specific codes.
3. What is contained in the two parts of the ICD-10-CM manual?
What is contained in the two parts of the ICD-10-
CM manual is the Index which contains a list of diseases in alphabetical order; and the Tabular List which contains
the actual codes arranged according to classification of the disease or condition or factors influencing health status
or contact with health services.
4. What is the format of an ICD-9-CM code? An ICD-10-CM code?
An ICD-9-CM code consists of three characters
usually followed by a decimal point and one or two numbers. The first character may be a letter or a number, but all
other characters are numeric. An ICD-10-CM code begins with three characters followed by a decimal point. The
first character is a letter, and the next two characters are usually digits. These three characters stand for the basic
condition. Up to four characters follow the decimal point, and they make the code more specific.
5. Describe the steps to look up a diagnosis code properly.
The steps to look up a diagnosis code properly is to look
up the patient's first listed diagnosis in the Index. This may be an actual diagnosis or a symptom. Then find the
number range in the Tabular List (Volume 1) and determine the code as specifically as possible. Then code all other
coexisting diagnosis.
6. What are “Z” codes and when are they used?
Z codes are used in the ICD-10-CM when the patient does not have
a disease or injury. A Z code may
be used as a secondary code if the patient has an underlying condition, such as a
penicillin allergy, that influences the treatment of the primary condition.
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7. What are external cause codes and when are they used?
External cause codes are used in combination with other
diagnosis codes to give more information about the cause of a condition or injury. They facilitate the collection of
statistics.
8. What is the difference between “Excludes 1” and “Excludes 2” when found under an ICD-10-
CM category code?
"Excludes 1" means that the condition is not coded with this code, and the patient cannot have
both the excluded condition and the condition listed above it. "Excludes 2" means that the condition is not coded
with this code, but the patient can have both the condition covered by this code and the excluded condition.
9. If a patient has two related conditions, which is coded first?
The underlying condition is coded first.
10. What is a sequela, and how does it affect the ICD-10-CM code?
A sequela is any condition that results from a
disease, injury, or treatment for a disease or injury. If a condition is a sequela, it usually requires an S as the last
character.
11. How does Medicare use medical necessity related to diagnosis and procedure coding?
Medicare uses specific
combinations of diagnosis and procedure codes to determine procedures that it will pay for because they are
medically necessary.
12. What are National Coverage Determinations (NCDs)?
NCDs describe coverage criteria by linking diagnosis
codes that support specific procedure codes.
13. Differentiate between Upcoding and downcoding. Why might each occur.
Upcoding is assigning a code with a
higher level of service than the service provided or separating a laboratory panel into individual test codes.
Downcoding is assigning a code that reflects a lower level of service than the care provided. Upcoding usually
occurs in an attempt to increase insurance reimbursement. Downcoding may occur in order to avoid audits.
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