A condition that arises during the hospital stay that prolongs the length of stay is

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Rasmussen College, Saint Cloud *

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MISC

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Mechanical Engineering

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Jan 9, 2024

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A condition that arises during the hospital stay that prolongs the length of stay is: 1. Comorbidity 2. Complication 3. First-listed diagnosis 4. Suspected condition Complication Following the coding process, the next step in the revenue cycle flow is: Billing In ICD-10-PCS coding, it is the coder’s responsibility to interpret the provider’s documentation in alignment with PCS definitions for the character values. False CMS is an organization that oversees private insurance companies TRUE  Definition of Coding It is important to understand what coding actually is. There are many misconceptions about coding. For example, it is not just data entry of numbers and codes. Coding is reading and interpreting documentation provided by a physician and translating that documentation into alphanumerical codes for the diagnosis(s) documented and for any treatment or services documented in the patient chart. The codes are then used for purposes of billing Medicare, Medicaid, commercial payers, or other third-party insurance companies for payment. Codes are also used for reporting statistics and data to the state and federal governments. Coding is serious business and is an important function in many healthcare settings such as hospitals, physician offices, outpatient surgical centers, health maintenance organizations, mental health care facilities, long term care facilities, rehabilitation facilities, and skilled nursing facilities. Coding specialists are also employed in insurance and billing companies, government agencies. In addition, coders may be called upon to assist with cancer reporting. The good news is that the demand for quality, skilled, and educated individuals in the Health Information field continues to grow.

 Role of Coding Coding is a critical role in what is called the "revenue cycle." Without coding, the revenue cycle would not be complete. The revenue cycle starts with patient registration and continues with the facility providing the treatment and/or services for the patient, submission of the appropriate charges for billing, and completion of the clinical documentation in the patient's medical record (chart) in a timely manner. Coding can be called the "lynch pin" in the revenue cycle and occurs following the completion of the documentation by the provider(s) involved in the patient's care. All aspects of the revenue cycle are important and need to be performed efficiently and effectively, but the application of the appropriate coding system(s) is what bridges the clinical documentation regarding the treatment/services provided and the ultimate reimbursement for the treatment/services performed. Therefore, coding with skill, accuracy, and integrity is critical in the Health Information field and the revenue cycle.  Coding Skill Set Coding skill and accuracy are critical in the health information field. In addition to high-quality coding skills, coding integrity is also extremely important. Coding with integrity involves the following aspects:  Understanding and applying the Official Coding Guidelines provided in each code book when assigning codes.  Understanding the legal aspects of coding.  Understanding the standards set for coding.  Understanding coding ethics.  Main Coding Systems There are three main coding systems.  ICD-10-CM - Coding system used for inpatient and outpatient diagnosis coding.  ICD-10-PCS - HIPAA Mandated Coding system used for inpatient procedure coding only.  CPT - Coding system used for outpatient procedures and service coding and includes diagnostic tests.  Specialized Coding Systems The following specialized coding systems are used in addition to the three main coding systems.  CDT - The coding classification system used for dentistry

 HCPCS Level II Codes - also called National Codes and are maintained by CMS. These codes (not Level I CPT codes) are used to charge for medical services, equipment, and supplies.  DSM-V - Diagnostic and Statistical Manual of Mental Disorders - A set of codes used in billing for the treatment of patients with substance abuse disorders and mental disorders. These codes are designed to help the payer understand better the nature of what is being treated. This coding system is built based on five "groups" called, Axis I, Axis II, Axis III, Axis IV, and Axis V. These groupings give detail to the choice of diagnosis and treatment.  Coding Tools Official Coding Guidelines The Official Coding Guidelines for ICD-10-CM and ICD-10-PCS are provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). The guidelines are a set of rules intended to provide direction in the assignment of codes using ICD-10 code sets. The guidelines are updated annually for implementation on October 1st. The American Medical Association (AMA) maintains the CPT coding guidelines. The specific guidelines are located at the beginning of each section and at the beginning of each code set in the CPT code book. The guidelines define items that are necessary to appropriately interpret, and report procedures and services contained in each section. The guidelines are updated annually.  Coding Books Each of these coding systems has their own code book. To become a successful coding specialist and a successful Health Information employee, it is vital to know how to use each coding system and their coding books. The ICD-10 code books are updated annually for implementation on October 1st of each year. The CPT code books are updated annually for implementation after the first of the year.  Coding Software Coding software, called an encoder , is a tool that assists coders in assigning codes. An encoder is a form of an electronic code book that employs coding decision pathways to assist the coder in the determination of diagnosis and procedure codes based on information entered into the system by the coder or via interfaces with other systems. It is very important that all coders have well-developed coding skills and know-how to use their code books as well as the coding software.

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There are two coding software systems used in all Rasmussen coding courses. Those software systems are the 3M Encoder and the Clintegrity Encoder. You will learn how to use both systems in this course. Computer-assisted coding (CAC) is another software tool designed to help in the coding process. True to its name, CAC is intended to “assist” and not replace the coder in the coding process. CAC software interfaces with electronic health record (EHR) systems to generate codes directly based on clinical documentation in the electronic record. To be utilized effectively, the coder must read the full medical record in order to validate the codes determined by the CAC review of the documentation.  Summary  Remember that learning how to code is like learning a foreign language, and each coding system is a different language. Therefore, be patient with your learning curve.  As with learning a foreign language, it is very important to practice, practice, and practice to become a skilled coder.  Coding is a skill to be learned. Always ask questions for clarification during the learning process. The ICD-10-CM system is used for coding diagnosis(s) for both inpatients and outpatients with a unique set of codes and specific coding guidelines. A diagnosis is a word or phrase stated by the provider in their clinical documentation to identify a disease or condition treated during the health care visit. The Official Coding Guidelines are located in the front of the ICD-10-CM Code Book. The code book and coding guidelines are updated annually and effective with services and discharges occurring on or after October 1 of each year. An ICD-10-CM code consists of 3 to 7 alphanumeric characters. The first character of the code is always an alphabetical character, and the second character is always numeric. All letters are used in the ICD 10 CM coding system. A decimal point is placed after the first three characters, which defines a “category.” A placeholder character is used in ICD-10-CM and is always the letter X. The placeholder is used for future expansion of the code, and when a code consists of fewer than six characters and a seventh character extension is required. Example: T58.11XA-Toxic effect of carbon monoxide from utility gas, accidental, initial encounter.

Main Terms, Alphabetic Index, and Tabular List There are two sections to the system. The first is an alphabetical listing of medical terms and corresponding codes. The second section is the Tabular List of codes divided into chapters based on body systems, conditions, diseases or injury. The Alphabetic Index is organized with Main Terms listed in alphabetical order. Main terms are in boldface and consist of diseases (pneumonia), conditions (laceration), nouns (syndrome), and adjectives (large). Indented beneath the Main Term will be any applicable Subterms, which are called essential modifiers . Example: Otitis media The Main Term is “otitis” with “media” as an essential modifier. The code is indicated to be H66.9- in the Alphabetic Index. However, coders are never to code solely from the Alphabetic Index. The code provided in the Alphabetic Index for the disease or condition is then looked up in the Tabular List for further expansion and validation based on clinical documentation in the patient’s medical chart.