HCR 201 Coding Analysis

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HCR 201 Medical Billing and Coding: Week 2 Summative Assessment: Coding Analysis 2/20/2024 ICD-10 CPT HCPCS Description and Purpose of Code Set ICD-10, the International Classification of Diseases, 10 th Edition, is a globally adopted code set designed to systematically classify and code various diseases, medical conditions, and procedures. Its alphanumeric codes offer a precise and standardized means of documenting health information, enhancing communication among healthcare professionals, insurers, researchers, and policymakers. ICD-10 plays a vital role in improving the accuracy of billing, facilitating epidemiological research, and supporting effective healthcare data management on an international level. CPT, or Current Procedural Terminology, is a standardized set of medical codes established by the American Medical Association. These codes serve the purpose of providing a consistent language for reporting a range of medical procedures and services performed by healthcare professionals. Used extensively in the United States, CPT codes play a vital role in accurately documenting and communicating information for billing, insurance reimbursement, and statistical analysis within the healthcare system. Category I corresponds to specific procedures or services. Category II codes are optional and used for performance measurement. Category III are temporary alphanumeric codes that represent new and developing technology. The Healthcare Common Procedure Coding System (HCPCS) is a standardized set of codes used in the United States to report and bill medical services to Medicare and other health insurance programs. Developed by the Centers for Medicare and Medicaid Services (CMS), HCPCS has two levels. Level I codes align with Current Procedural Terminology (CPT) and cover procedures like physician visits and surgeries. Level II codes, alphanumeric in nature, encompass a broader range, including durable medical equipment and medications. HCPCS aims to provide a consistent coding system for streamlined communication, billing, and reimbursement, particularly within government healthcare programs. How Code is Used The ICD-10 is used as a standardized system for classifying and coding various diseases, conditions, and medical procedures. The primary uses of ICD-10 include: The CPT is utilized in various ways within the healthcare industry: 1. Procedural Coding: CPT codes are employed to represent and document medical procedures and The HCPCS is used in various ways in the healthcare industry: 1. Coding for Medicare and Medicaid Services: HCPCS Level II codes are used to identify and code a wide

1. Diagnostic Coding: ICD-10 codes are used by healthcare providers to document and represent patient diagnoses accurately. These codes are essential for maintaining comprehensive and standardized health records. 2. Billing and Reimbursement: Health Insurance claims require 1CD-10 codes to accurately reflect the medical conditions and procedures associated with a patient’s treatment. 3. Clinical Decision-Making: Healthcare professionals use ICD-10 codes to communicate effectively about patient’s health conditions and to make informed decisions regarding treatment plans and interventions. services performed by healthcare professionals. These codes cover a wide range of activities, including surgeries, diagnostic tests, office visits, and other medical interventions. 2. Billing and Reimbursement: CPT codes play a crucial role in the billing process. When healthcare services are provided, CPT codes are assigned to accurately describe the procedures performed. These codes are then used on insurance claims to facilitate billing and ensure proper reimbursement from insurance providers. 3. Communication Between Healthcare Providers: CPT codes provide a standardized language for healthcare professionals to communicate about the services they deliver. This helps ensure clarity and precision in conveying information related to range of healthcare services, supplies, and equipment not covered by CPT codes. These codes are particularly important for billing and reimbursement under Medicare and Medicaid. 2. Durable Medical Equipment (DME) Coding: HCPCS Level II includes codes specifically for DME, such as wheelchairs, crutches, and medical supplies. 3. National Uniform Billing (NUB) Form: HCPCS codes are used on the NUB claim form, which is often utilized for institutional billing, such as in hospitals. 4. Medicare Advantage Plan Billing: HCPCS codes are used for billing services covered by Medicare Advantage plans. 5. State Medicaid Programs: HCPCS codes are widely used in state Medicaid programs to code and bill for various healthcare services and supplies. 6. Coding for Ambulance

medical procedures and treatments. Services: HCPCS Level II includes codes for ambulance services. Examples of Each Code Set ICD-10-CM: L51.1 – Stevens-Johnson syndrome B35.9 - Dermatophytosis, unspecified Ringworm NOS ICD-10-PCS: 6A750Z4 – Dialysis of blood, single vessel, arteriovenous shunt 0FB03ZX – Resection of prostate, percutaneous approach, no device CPT Codes: 25392 – Osteoplasty, radius AND ulna; shortening (excluding 64876) 88360 – Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual 99202 – new patient office visit, 15 minutes met or exceeded 00566 – Anesthesia for direct coronary artery bypass grafting; without pump oxygenator HCPCS: C8910 – Magnetic resonance angiography without contrast, chest (excluding myocardium) G0305 – Post-discharge pulmonary surgery services after LVRS, minimum of 6 days of services L5700 – Replacement, socket, below knee, molded to patient model

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References American Medical Association. (2023). CPT Professional 2024 . American Medical Association. CPT® overview and code approval . (n.d.). American Medical Association. Retrieved February 20, 2024, from https://www.ama-assn.org/practice-management/cpt/cpt-overview-and-code-approval HCPCS - General Information . (n.d.). CMS. Retrieved February 20, 2024, from https://www.cms.gov/medicare/coding-billing/healthcare- common-procedure-system HCPCS Level II Expert 2024 . (2023). AAPC. ICD-10-CM Complete Code Set 2024 . (2023). AAPC. Valerius, J., Bayes, N., Newby, C., & Blochowiak, A. (2019). Loose Leaf for Medical Insurance: A Revenue Cycle Process Approach . McGraw-Hill Education. What Is ICD-10? (n.d.). AAPC. Retrieved February 20, 2024, from https://www.aapc.com/resources/what-is-icd-10