Survey: How is

ICD-10 Going at
Your Practice?

December 02, 2015 | ICD-10, Coding

, Compliance, ICD-9By
Physicians Practice Staf
• It’s been two months since ICD-10
has gone into effect. How has your
practice been dealing with the
transition?
• Was the transition "much to do
about nothing" or a huge headache?
Do you think another delay should
have happened, or not?
• Take this quick five-question survey from
Physicians Practice and share your
experiences thus far with ICD-10.  We
will compile your responses and share
them with our readers in an effort to
better understand how the transition is
affecting practices.
• Take this quick five-question survey from
Physicians Practice and share your
experiences thus far with ICD-10.  We will
compile your responses and share them with
our readers in an effort to better understand
how the transition is affecting practices.
 Linked Articles
• Cautious Optimism in the Early Days of ICD-10
• How One Doc Made ICD-10 Work
• Payers Won't Always Be So Lenient in ICD-10
• ICD-10 is Here: Now What?
• ICD-10 Transition: Monitor to Catch Problems
Early

• At One Month, ICD-10 Seems To Be Going Smo

othly
• Survey: How is ICD-10 Going at Your Practice?
• One Doc 'Pleasantly Surprised' by ICD-10 Transition
• Train Staff to Address ICD-10 Related Coder Shortage
• Despite Minor Issues ICD-10 Rollout Is Smooth
• One Practice's ICD-10 Experiences at Six Months
• How Practices Are Faring with ICD-10 at Six Months
• As ICD-10 Enters Year Two, Practices Reflect on Transition
• Set Your ICD-10 Goals for 2016
 Medical coding is an integral part
• Medical coding is an integral part of medical billing and
communications among healthcare providers and insurers. Learn
the basics of what it means and how these codes are used.
• What Is Medical Coding?
• Medical coding is a system of number and letter labels that are
unique for each diagnosis, symptom or symptom set, and cause of
death in human beings.
• Additionally, codes are used for standard communication of
supplies and procedures used in the treatment of human
conditions.
• Accurate medical coding is important for billing and in tracking
statistics for disease and medical treatment.
THE FOLLOWING TYPES OF CODES
• Medical coding can involve one or more of the
following types of codes: ICD codes, CPT
codes, HCPCS codes, DRG codes, and
modifiers. All of these coding sets are
important for communication and billing
purposes.
• .
 ACCEPTABLE CODES
• Not only is coding important in a medical
practice, it is imperative because commercial
payers such as insurance companies, Medicare
and Medicaid will not pay a claim if is it not
properly submitted with acceptable codes
 ICD CODES
• The International Statistical Classification of Diseases or
ICD codes is one system of codes. These are specific to
classifications of diagnoses, symptoms, and causes of death in
humans.
• The World Health Organization creates, copyrights, and oversees
these classifications and they are standard and thereby
recognizable by every medical facility and practitioner
worldwide.
• In the United States the National Center for Health Statistics,
which is a part of the Centers for Medicare and Medicaid
Services manages any amendments to the ICD codes alongside
the WHO.
 Healthcare Common Procedure Coding
System
• The HCPCS (Healthcare Common
Procedure Coding System) levels I and II
is another coding system. Level I is
comprised of CPT codes, and Level II
includes alphanumeric codes which are
used to identify products, supplies, and
services not included in the CPT codes
when used outside a physician's office.
 HCPCS codes are defined in three
• HCPCS codes are defined in three levels:
• Level I CPT (Current Procedural Terminology)
codes are made up of 5 digit numbers and
managed by the American Medical Association
(AMA). CPT codes are used to identify medical
services and procedures ordered by physicians
or other licensed professionals.
 Level II HCPCS
• Level II HCPCS are alpha numeric codes
consisting of one alphabetical letter followed
by four numbers and are managed by The
Centers for Medicare and Medicaid Services
(CMS). These codes identify non-physician
services such as ambulance services, durable
medical equipment, and pharmacy.
Level III codes are alphanumeric codes W, X,
Y, or Z
• Level III codes are alphanumeric codes W, X, Y,
or Z followed by a four digit numeric code.
Otherwise known as local codes, these codes
are used as a miscellaneous code when there
is no level I or level II code to identify it.
 The HCPCS (Healthcare Common Procedure
Coding System)

• The HCPCS (Healthcare Common Procedure

Coding System) levels I and II is another coding
system. Level I is comprised of CPT codes, and
Level II includes alphanumeric codes which
are used to identify products, supplies, and
services not included in the CPT codes when
used outside a physician's office.
 HCPCS codes
• HCPCS codes are defined in three levels:
• Level I CPT (Current Procedural Terminology)
codes are made up of 5 digit numbers and
managed by the American Medical Association
(AMA). CPT codes are used to identify medical
services and procedures ordered by physicians
or other licensed professionals.
 HCPCS codes are defined in three levels:

• Level I CPT (Current Procedural Terminology)

codes are made up of 5 digit numbers and
managed by the American Medical Association
(AMA). CPT codes are used to identify medical
services and procedures ordered by physicians
or other licensed professionals.
 HCPCS codes are defined in three levels:

• Level II HCPCS are alpha numeric codes

consisting of one alphabetical letter followed
by four numbers and are managed by The
Centers for Medicare and Medicaid Services
(CMS). These codes identify non-physician
services such as ambulance services, durable
medical equipment, and pharmacy.
Level III codes are alphanumeric codes W, X,
Y, or Z
• Level III codes are alphanumeric codes W, X, Y,
or Z followed by a four digit numeric code.
Otherwise known as local codes, these codes
are used as a miscellaneous code when there
is no level I or level II code to identify it.
 CPT Codes
• CPT Codes
• CPT codes are Common Procedural Codes and were
developed and trademarked by the American Medical
Association in 1966. These are a system of five character
alphanumeric codes that describe in a standardized method
medical, surgical, and diagnostic services.
• DRG Codes
• DRG codes, diagnosis related grouping codes, are only used
to code inpatient claims.
• Many insurers pay according to the DRG, therefore, the
accuracy of all components is essential to proper claim
reimbursement.
 How Medical Coding is Used
• These coding sets are important for
communication and billing purposes. Not
only is coding important in a medical
practice, it is financially critical for medical
providers because commercial payers such
as insurance companies,
• Medicare and Medicaid will not pay a claim
if is it not properly submitted with
acceptable codes.
 DIAGNOSIS CODES ARE USED TO ANALYZE
DISEASE
• Additionally, diagnosis codes are used to
analyze disease patterns in societies and for
national and regional health and death
statistics. Member countries of The World
Health Organization can then benefit from
needed resources to combat widespread
health issues, to educate the populace on
prevention and treatment, and to ensure
future health and well-being for their citizens.
 Education in Medical Coding

• Many colleges and trade schools offer classes,

certifications, even Associate of Applied Science
degrees in medical billing and coding. These are in-
depth courses or degree plans that educate
students on medical terminology, proper coding
and billing techniques, proper office procedures,
and an abundance of related coursework. Some of
these are accredited and some are not, so each
potential student should do their homework before
choosing a learning program.
 The importance of initial education and
continuing education
• in a clinic or doctor’s office cannot be
overstated. Staying abreast of the changes in
coding and billing practices, as well as
governing regulations is essential in this fast
paced digital system in which we all work and
live.
 Coding and Billing
• Coding and billing are often mentioned
together because these are two facets of the
medical office that are closely linked to one
another. The staff member(s) who complete
your medical coding and billing should work
closely together to ensure accurate and
prompt payment of all medical claims and
correct and complete medical records.
 Resources such as up to date code books
• Resources such as up to date code books listing the
various codes or current software for coding or billing are
imperative to the billing and coding staff in order to
ensure accurate filing to insurance companies or
Medicare and Medicaid, and prompt payment from these
entities, as well as accurate diagnosis and medical
records. In addition to the initial filing of patient claims,
the coder and or biller may be responsible for following
up on denied claims by auditing the patient’s chart, re-
filing the claim, appealing the claim, or taking other steps
to ensure the accuracy of the claim.
 Medicare and Medicaid
• Medicare and Medicaid, and prompt payment
from these entities, as well as accurate
diagnosis and medical records. In addition to
the initial filing of patient claims, the coder
and or biller may be responsible for following
up on denied claims by auditing the patient’s
chart, re-filing the claim, appealing the claim,
or taking other steps to ensure the accuracy of
the claim.
 Coding and Billing
• Given that medical and billing staff are
responsible for the accuracy of
medical records in accordance with state and
federal regulations as well, the importance of
competent billers and coders cannot be
overstressed. A successful medical facility
must have well trained, organized, and
proficient medical billers and medical coders.
 CPT Codes
• CPT Codes
• CPT codes are Common Procedural Codes and were
developed and trademarked by the American Medical
Association in 1966. These are a system of five character
alphanumeric codes that describe in a standardized
method medical, surgical, and diagnostic services.
 DRG Codes
• DRG codes, diagnosis related grouping codes,
are only used to code inpatient claims.
• Many insurers pay according to the DRG,
therefore, the accuracy of all components is
essential to proper claim reimbursement.
 Education in Medical Coding

• Many colleges and trade schools offer classes, certifications, even

Associate of Applied Science degrees in medical billing and coding.
These are in-depth courses or degree plans that educate students
on medical terminology, proper coding and billing techniques,
proper office procedures, and an abundance of related coursework.
Some of these are accredited and some are not, so each potential
student should do their homework before choosing a learning
program.
• The importance of initial education and continuing education in a
clinic or doctor’s office cannot be overstated. Staying abreast of the
changes in coding and billing practices, as well as governing
regulations is essential in this fast paced digital system in which we
all work and live.
The importance of initial education
• The importance of initial education and
continuing education in a clinic or doctor’s
office cannot be overstated. Staying abreast of
the changes in coding and billing practices, as
well as governing regulations is essential in
this fast paced digital system in which we all
work and live.
 Coding and Billing
• Coding and billing are often mentioned
together because these are two facets of the
medical office that are closely linked to one
another. The staff member(s) who complete
your medical coding and billing should work
closely together to ensure accurate and
prompt payment of all medical claims and
correct and complete medical records.
 Medicare and Medicaid,
• Resources such as up to date code books listing the
various codes or current software for coding or billing are
imperative to the billing and coding staff in order to
ensure accurate filing to insurance companies or
Medicare and Medicaid, and prompt payment from these
entities, as well as accurate diagnosis and medical
records. In addition to the initial filing of patient claims,
the coder and or biller may be responsible for following
up on denied claims by auditing the patient’s chart, re-
filing the claim, appealing the claim, or taking other steps
to ensure the accuracy of the claim.
 medical records
• Given that medical and billing staff are
responsible for the accuracy of
medical records in accordance with state and
federal regulations as well, the importance of
competent billers and coders cannot be
overstressed. A successful medical facility
must have well trained, organized, and
proficient medical billers and medical coders.