CodingClassifications
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Medicine
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Apr 3, 2024
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Medical Coding Classification Systems
Kaeyty Richardson
University of Cincinnati
HCMT 1017: ICD Medical Coding I
Professor Galinger January 30, 2024
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There are many different coding classifications in the world of medical coding. Being familiar with each classification system is important in a career as a medical coder. I plan to review six different classification systems: ICD-9, ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and DSM-V. Each system has a unique role in the healthcare coding system. The International Classification of Diseases, Ninth Revision (ICD-9) was the first major coding classification system used for medical billing and coding. This classification was maintained by the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid (CMS). ICD-9 has
since transitioned into the ICD-10-CM and ICD-10-PCS when implemented in 2015. ICD-9 was developed to code and classify morbidity data from inpatient, outpatient, and physician office records. It consisted of a tabular list that contained a numerical list of disease code numbers, an alphabetical index to the disease entries, and a classification system for surgical, diagnostic, and therapeutic procedures. As mentioned, in 2015 The International Classification of Diseases, Tenth Revision (ICD-10) was implemented. This is an upgraded version of ICD-9, including more codes and classified categories, and operates under two systems: ICD-10-CM (clinical modification) and ICD-10-PCS (procedural coding system). The NCHS also maintains the ICD-10 and has developed the ICD-10-CM for classification of morbidity purposes. The clinical modification includes additional information relevant to ambulatory and
managed care encounters, expanded injury codes, the creation of combination diagnosis/symptom codes, incorporation of common fourth and fifth-digit subclassifications, laterality, and more specific code assignments. The ICD-10 procedure coding system was developed for CMS, and this is the governmental agency responsible for overseeing all changes and modifications. It is the official system used to assign codes associated with hospital utilization for procedure codes. ICD-10-PCS codes are alphanumeric codes and are seven characters long. The Current Procedure Terminology (CPT), developed and maintained by the American Medical Association (AMA), is also used for coding procedures like ICD-10-PCS. CPT has three categories that
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include five-digit codes used to describe a procedure or service, alphanumeric codes for tracking implementation quality, and provisional codes used for any new procedures or services. There are different categories of CPT codes as follows: Category I codes are used for procedures, services, devices, and drugs (including vaccines); Category II codes are used for performance measures and quality of care;
and Category III codes are used for services and procedures using emerging technology (these are usually temporary codes). The CPT classification forms the basis of HCPCS Level I codes, also used for services and procedures offered by healthcare providers. The Healthcare Common Procedure Coding System (HCPCS) is another important coding classification system. HCPCS plays a vital role in accurate billing and reimbursement for government healthcare programs, such as Medicare and Medicaid. As previously mentioned, HCPCS codes are based on CPT codes and contain two levels of codes. Level I codes are identical to CPT codes and codes cover physician and outpatient services. HCPCS Level II codes cover non-physician services, durable medical equipment, and other miscellaneous items. The last coding classification system I am going to review is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-V). This coding classification system is produced by the American Psychiatric Association (APA) and is used by clinicians and psychiatrists to diagnose and classify
mental disorders. This coding system allows for an objective assessment of symptoms in many different clinical settings for both adults and children. The DSM-V has three parts which include diagnostic classification, diagnostic criteria sets, and descriptive text—necessary information for diagnosing mental health disorders. In overview, these six different coding classification systems are a huge part of medical billing and coding. These specific classifications are necessary in most areas of coding however, there are additional coding classifications that may also pertain to different careers. Currently, I work in outpatient billing and see codes from CPT, ICD-10-CM, and HCPCS code sets every day. This is different though from
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someone who works with hospitals and other inpatient settings, who will see more ICD-10-PCS codes. As
I initially stated, it is vital to familiarize yourself with all the different coding classification systems.
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References
Shah, R. (2021, December 3). A Complete Guide on Medical Coding Systems for 2022
. Osplabs. https://www.osplabs.com/insights/what-is-medical-coding-system-and-how-to-implement-it/
UMLS Metathesaurus - ICD9CM (International Classification of Diseases, Ninth Revision, Clinical Modification) - Synopsis
. (n.d.). Www.nlm.nih.gov. https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/ICD9CM/index.html
Centers for Disease Control and Prevention. (2022, April 6). ICD- 10 - CM International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
. Www.cdc.gov. https://www.cdc.gov/nchs/icd/icd-10-cm.htm
UMLS Metathesaurus - ICD10PCS (ICD-10 Procedure Coding System) - Synopsis
. (2020). Nih.gov; U.S. National Library of Medicine. https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/ICD10PCS/index.html
https://www.facebook.com/verywell. (2019). What Do CPT Codes Your Medical Bills Mean?
Verywell Health. https://www.verywellhealth.com/what-are-cpt-codes-2614950
relatore. (2023, July 6). Medical Coding Systems: ICD-10-CM, CPT, and HCPCS
. Relatore. https://www.relatoresolutions.com/blog/medical-coding-systems-icd-10-cm-cpt-and-hcpcs/
#:~:text=HCPCS%20codes%20are%20divided%20into%20two%20levels%3A%20Level
UMLS Metathesaurus - DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) - Synopsis
. (n.d.). Www.nlm.nih.gov. https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/DSM-5/index.html
Cherry, K. (2023, March 14). Diagnostic and Statistical Manual (DSM) overview
. Verywell Mind. https://www.verywellmind.com/the-diagnostic-and-statistical-manual-dsm-2795758