A patient calls it a sore throat, a doctor calls it pharyngitis and healthcare insurance calls it a 462. Each is accurate, but if the correct ICD-9 code isn’t entered or doesn’t match the diagnosis, the physician won’t be paid for his services.
Designating the right ICD-9 codes is essential to collect reimbursement claims and Nitin Chhoda offers a crash course in the coding system.
ICD-9 codes are the internationally recognized three- to five-digit numerical designations for each condition and disease.
The codes are organized into three categories known as volumes that are used by medical professionals across the nation for billing purposes when submitting reimbursements claims.
Medical Codes Development
Developed by the World Health Organization, the system is comprised of volume 1, a compendium of diagnosis codes for diseases and conditions.
Volume 2, arranged in alphabetical order, provides an index to diagnostic procedures and volume 3 lists procedure codes. The system is set to be updated in Oct. 2014 to the new ICD-10 codes.
The new system reflects advances in medical terminology and technology, and enables practitioners to provide more detailed information to insurance companies. Early preparation for the switch is advised, as those in the medical profession are anticipating some disruptions during the transition.
The Coding System
The ICD system links a diagnosis with a procedure for billing purposes. The codes tell insurance companies why the client met with the clinician, the diagnosis, and procedure or treatment that was provided to return the patient to health. The codes are further broken down into subcategories and sub-classifications.
ICD-9 codes offer provisions for making a multiple diagnosis, which can also be entered in an electronic medical records system. The first diagnosis code is used to explain the reason the client was seeking care. Other conditions may be observed during the examination or be part of the patient’s medical history.
Those are placed second and third on claim forms as contributing factors, already existing conditions and complications, providing a source of supporting evidence.
Medical professionals must also be cognizant of the abbreviations, punctuation and symbols used within the codes, known as conventions.
Proper Coding is Essential
It’s critical that the proper coding is entered on reimbursement requests and that a practice’s billing and coding specialist is well versed in their craft. Codes that don’t match the diagnosis or procedures taken will be delayed, denied or questioned as to the medical necessity of the action taken. Even simple mistakes will severely interrupt a clinic’s cash flow.