Type of paper: Research Paper

Topic: Medicine, Health, Change Management, Services, Classification, Business, Health Care, Management

Pages: 2

Words: 550

Published: 2020/11/28

Today, the healthcare industry in United States (US) is undergoing an administrative transformation. Medical coding systems are being increasingly adopted by healthcare payers to ensure accurate reimbursement of the healthcare providers. The different coding systems include the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS). (Aapc.com, 2015)
The ICD-9-CM classification has evolved from the World Health Organization’s Ninth Revision, International Classification of Diseases. ICD-9-CM classification includes only diagnostic codes that consist of a list of disease code numbers, a disease index in alphabetical order; and a classification system for the diverse healthcare procedures. Administration of the ICD-9-CM classification is the primary responsibility of the US federal organizations, the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS). (Cdc.gov, 2015)
The NCHS and CMS have established guidelines for the administration of the coding and reporting by the ICD-9-CM. These guidelines have been approved by four organizations that make up the Cooperating Parties for the ICD-9-CM. However, the instructions and conventions of the ICD-9-CM take priority over guidelines. The coding and sequencing instructions in Volumes 1, 2 and 3 of the ICD-9-CM provide the basis for these guidelines and additional instruction. The diagnosis codes from volumes 1 and 2 have been adopted from the Health Insurance Portability and Accountability Act (HIPAA) for all healthcare settings. The procedure codes from volume 3 have been adopted for inpatient procedures reported by hospitals. (ICD-9-CM, 2015)
Besides the conventional codes in ICD-9-CM, there are two types of supplemental codes: V codes and E codes. The V codes (V01–V91) are used for clinical encounters other than disease or injury. E codes represent cause of injury or poisoning, the intent and the location for the event. However, E codes are not mandatory in all institutions and states. E codes provide data for injury research and prevention strategies; and are not to be used as a primary diagnosis code. The guidelines do not differentiate the use of V codes from that of other codes; with the exception of E codes. (Acep.org, 2015)
The CPT code set is maintained by the American Medical Association since 1992 through the CPT Editorial Panel. The CPT code set identifies the services rendered rather than the diagnosis on the claim as done by the ICD-9-CM classification. The CPT codes are the most accepted medical nomenclature for reporting medical procedures and services under public and private health insurance programs. There are three types of CPT code which are described as under Category I, II, and III. (Ama-assn.org, 2015)
The Category I includes codes for evaluation and management, anaesthesia, medicine, surgery, radiology, pathology and laboratory. Category II codes for performance measurement will decrease the need for record abstraction and chart review, thereby minimizing administrative burden Category III contains a temporary set of codes for emerging technologies, services, and procedures. (Ama-assn.org, 2015) The evaluation and management (E/M) codes cover a broad range of services for patients in both inpatient and outpatient settings. The E/M codes are generic and they are to be used by all physicians and other healthcare professionals. They are also to be used in primary and specialty care. (Psychiatry.org, 2015)
The HCPCS was established in 1978 in order to standardize identification of medical services, supplies and equipment. The HCPCS coding were introduced to simplify medical billing and it was made compulsory under the 1996 HIPAA Act. The Level I code of the HCPCS set is a five-digit numeric code that contains the CPT. The Level II code set of the HCPCS is for medical services not included in Level I, such as durable medical equipment, prosthetics, orthotics and supplies. These codes are alpha-numeric in that they begin with a single letter. Medicare and Medicaid are both required to use HCPCS codes (Straube, 2015)


Aapc.com,. (2015). What is Medical Coding? - AAPC. Retrieved 26 February 2015, from https://www.aapc.com/medical-coding/medical-coding.aspx
Acep.org,. (2015). V and E Codes FAQ. Retrieved 26 February 2015, from http://www.acep.org/Clinical---Practice-Management/V-and-E-Codes-FAQ/
Ama-assn.org,. (2015). About CPT®. Retrieved 26 February 2015, from http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt.page?
 Cdc.gov,. (2015). ICD - ICD-9-CM - International Classification of Diseases, Ninth Revision, Clinical Modification. Retrieved 26 February 2015, from http://www.cdc.gov/nchs/icd/icd9cm.htm
ICD-9-CM Official Guidelines for Coding and Reporting. (2015). Retrieved 26 February 2015, from http://www.cdc.gov/nchs/data/icd/icd9cm_guidelines_2011.pdf
Psychiatry.org,. (2015). Codes and documentation for Evaluation and Management Services. Retrieved 26 February 2015, from http://www.psychiatry.org/file%20library//codes-doc-fore-m-wvignettes.pdf
Straube, D. (2015). HCPCS Codes: Frequently asked questions.. Retrieved 26 February 2015, from http://www.easystand.com/documents/2012/12/faqs-about-hcpc-codes.pdf

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