AMCI ICD-10-CM Coding for Beginners- Part 2

AMCI Medical Coding

4 Jan 202194:24

EducationalLearning

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TLDRThis comprehensive guide delves into the intricacies of ICD-10-CM coding, focusing on conventions, general coding guidelines, and the importance of understanding the structure and nuances of the coding system. The presentation highlights the differences between billers and coders, emphasizing that while both professions are crucial in the healthcare system, they follow distinct guidelines. The video script provides a detailed walkthrough of ICD-10-CM coding principles, including the use of abbreviations, punctuation, and specific coding scenarios. It also introduces the concept of sequela and late effects, and the necessity of using combination codes when applicable. The guide concludes with a quiz to reinforce learning and prepare coders for advanced ICD-10-CM coding mastery.

Takeaways

📚 Introduction to ICD-10-CM part two focuses on conventions, general coding guidelines, and testing knowledge through scenarios and quizzes.
👩‍🏫 Mrs. J emphasizes the difference between medical coders and billers, noting that coders follow coding guidelines while billers adhere to payer guidelines.
📈 The presentation outlines 19 conventions in section one, which include guidelines on the alphabetic index, format and structure of codes, and specific coding guidelines for ICD-10-CM.
🔍 ICD-10-CM codes should be looked up in the alphabetic index first, then verified in the tabular list, as per guideline B1.
🎯 The level of detail in encoding (guideline B2) requires using the highest number of characters possible for ICD-10 codes, based on the doctor's documentation.
🌟 NOS (Not Otherwise Specified) and NEC (Not Elsewhere Classifiable) are key abbreviations in ICD-10-CM, representing non-specific and specific but not listed diagnoses, respectively.
📌 The use of signs, symptoms, and unspecified codes (guideline B18) is permitted when a definitive diagnosis is not provided in the medical documentation.
🔄 Sequencing of codes is crucial, with acute conditions listed before chronic conditions (guideline B8) and the condition being treated listed before any sequela or late effects (guideline B10).
📝 Documentation by non-physician clinicians is restricted to specific circumstances such as BMI, stages of pressure ulcers, and certain scales (guideline B14).
💡 The presentation concludes with a quiz to test understanding of ICD-10-CM conventions and general coding guidelines, preparing coders for part three on selecting the first listed code.

Q & A

What is the primary goal of the presentation on ICD-10-CM coding?
-The primary goal of the presentation is to review ICD-10-CM conventions and general coding guidelines, provide scenarios and quizzes, and bring the participants closer to ICD-10-CM coding mastery.
What is the difference between medical coders and medical billers?
-Medical coders transform a doctor's documentation into medical codes, while medical billers put these codes into the system for payment processing. Coders follow coding guidelines, whereas billers follow payer guidelines, indicating distinct skill sets and roles.
What are the three categories and four sections of ICD-10-CM guidelines?
-The three categories are conventions, general coding guidelines, and specific coding guidelines for ICD-10-CM. The four sections are Section One, Section Two, Section Three, and Section Four, with Sections One and Four being particularly relevant for professional coders.
What does the abbreviation 'NOS' stand for in ICD-10-CM coding?
-NOS stands for 'Not Otherwise Specified', indicating that the doctor's diagnosis was not specific enough to match a more detailed code within the ICD-10-CM manual.
What does the abbreviation 'NEC' stand for in ICD-10-CM coding?
-NEC stands for 'Not Elsewhere Classifiable', which means the doctor provided a specific diagnosis that is not listed in the ICD-10-CM manual.
What is the significance of the 7th character extender in ICD-10-CM codes?
-The 7th character extender provides additional information about the condition, such as laterality (side) or external cause, and is used to enhance the specificity of the code when required.
What are 'manifestation codes' in the context of ICD-10-CM?
-Manifestation codes are used to identify a sign, symptom, or condition related to an underlying illness or disease. They cannot be used as a principal diagnosis and must be coded when present.
How is the term 'and' used in ICD-10-CM coding?
-The term 'and' in ICD-10-CM indicates that both conditions listed must be present, and it is used to describe a combination of conditions in a single code.
What is the purpose of 'includes notes' and 'excludes notes' in ICD-10-CM coding?
-Includes notes are used to further define, clarify, or give examples of a code category, while excludes notes indicate which diagnoses should not be coded with a specific code or require the presence of two diagnoses for coding.
What is the significance of laterality in ICD-10-CM coding?
-Laterality in ICD-10-CM coding is important for specifying whether a condition affects the right, left, or both sides of the body, and it is determined by the fourth, fifth, or sixth character of the code.

Outlines

00:00

🎓 Introduction to ICD-10-CM Part Two

Mrs. J, the curriculum director at AMCI and an ICD-10-CM instructor, continues the series on ICD-10-CM coding, building on the knowledge from part one. This segment focuses on reviewing ICD-10-CM conventions and general coding guidelines, interspersed with quizzes to test learners' understanding. The presentation aims to deepen the audience's mastery of ICD-10-CM coding, covering the distinction between medical coders and billers, the significance of coding and payer guidelines, and the introduction to the guidelines of ICD-10-CM.

05:02

🔍 Exploring ICD-10-CM Index and Guidelines

This section delves into the structure of the ICD-10-CM index, which is categorized into sections and subsections focusing on conventions, general coding, and specific coding guidelines. It emphasizes the importance of understanding the conventions within the ICD-10-CM, such as the use of the alphabetic index and tabular list, and how to interpret the format and structure of codes. The presentation aims to equip learners with the foundational knowledge necessary for navigating the complexities of medical coding.

10:04

🔑 Understanding ICD-10-CM Conventions

Mrs. J addresses the concept of conventions within the ICD-10-CM, highlighting 19 specific conventions that coders must be familiar with. These include understanding the use of the alphabetic index and tabular list, the structure of codes, and the significance of placeholder characters, among others. This segment is crucial for coders to grasp the standardized practices in ICD-10-CM coding, ensuring accuracy and consistency in their work.

15:04

📚 Decoding NEC and NOS Abbreviations

This paragraph focuses on two critical abbreviations in ICD-10-CM coding: NEC (Not Elsewhere Classifiable) and NOS (Not Otherwise Specified). Mrs. J explains how these abbreviations are used when a doctor's diagnosis is either too specific and not listed in the ICD-10-CM (NEC), or not specific enough (NOS). The segment is instrumental in teaching coders how to select the correct codes in scenarios where the diagnosis does not directly match the descriptions in the ICD-10-CM manual.

20:06

🖋️ Importance of Punctuation in ICD-10-CM

The use of punctuation such as parentheses, brackets, and colons in ICD-10-CM is elucidated. Parentheses enclose non-essential modifiers that do not affect the code, whereas brackets indicate manifestation codes or synonyms. Colons are used after an incomplete term that needs modifiers for a complete diagnosis. This segment educates coders on the nuanced role of punctuation in accurately interpreting and applying ICD-10-CM codes.

25:07

🧩 Navigating ICD-10-CM Notes and Guidelines

Mrs. J introduces the various notes found within the ICD-10-CM, such as 'includes,' 'excludes 1,' and 'excludes 2' notes, which are essential for coders to understand the scope and limitations of certain codes. These notes help in determining whether a condition should be coded in conjunction with another, or if it is not applicable at all, providing clarity on how to accurately document medical diagnoses and conditions.

30:09

📖 Detailed Look at ICD-10-CM Guidelines

This segment covers the comprehensive guidelines provided in ICD-10-CM, including the use of codes for reporting purposes, signs and symptoms coding, and the significance of acute and chronic conditions. Mrs. J explains the rationale behind each guideline, emphasizing their importance in ensuring accurate and ethical medical coding. This part of the presentation serves as a deep dive into the principles that govern medical coding practices.

35:12

🏁 Wrapping Up ICD-10-CM Part Two

The conclusion of part two involves a recap of the key points covered in the presentation, including the understanding of ICD-10-CM conventions, guidelines, and the differences between NEC and NOS codes. Mrs. J encourages coders to apply their knowledge through quizzes, reinforcing the learning objectives. The segment serves as a transition to part three, which will focus on selecting the first listed code and further mastering ICD-10-CM coding.

40:14

🚀 Transitioning to ICD-10-CM Part Three

Mrs. J sets the stage for part three of the series, promising to delve into the process of selecting the first listed code, a crucial aspect of ICD-10-CM coding. She emphasizes the importance of this next step in achieving coding mastery and encourages learners to take a break and prepare for the challenges ahead. This segment effectively bridges the gap between the foundational knowledge established in parts one and two and the advanced concepts to be explored in part three.

Mindmap

Keywords

💡ICD-10-CM

ICD-10-CM stands for the International Classification of Diseases, 10th Revision, Clinical Modification. It is a standardized coding system used in the United States for reporting medical diagnoses and procedures. The video script discusses various guidelines and conventions for using ICD-10-CM codes, emphasizing the importance of accurate coding for medical documentation and billing purposes.

💡Coding Guidelines

Coding guidelines are the rules and conventions that medical coders must follow when assigning ICD-10-CM codes to diagnoses and procedures. These guidelines ensure consistency and accuracy in the documentation of healthcare data. The video script provides an in-depth review of general coding guidelines, including laterality, syndromes, and complications of care.

💡Medical Coders and Billers

Medical coders and billers are distinct professionals within the healthcare industry. Coders are responsible for translating a physician's documentation into ICD-10-CM codes, while billers use these codes to submit claims for payment. The video script clarifies the difference in roles and the specific guidelines each profession follows.

💡Section One Guidelines

Section One Guidelines pertain to the general conventions and coding rules that are applied when using ICD-10-CM. These guidelines cover the structure of codes, abbreviations, punctuation, and other key aspects of coding. The video script provides a comprehensive overview of these guidelines, which are essential for accurate and effective medical coding.

💡7th Character Extender

The 7th Character Extender is an additional digit added to certain ICD-10-CM codes to provide more specificity. This extender is used to capture additional information about a diagnosis or procedure, such as laterality or external cause. The video script explains the importance of using the correct 7th character extender to ensure the highest level of specificity in coding.

💡Laterality

Laterality in medical coding refers to the specific side of the body on which a condition or procedure is performed. It is important for accurate documentation and billing. The video script explains how to determine laterality based on the fourth, fifth, or sixth character of an ICD-10-CM code.

💡Sequela

A sequela is a condition that is a consequence or late effect of an initial injury or disease. In medical coding, it is important to identify and code for sequela separately, using a specific 7th character extender. The video script explains the process of coding for sequela, including the use of two codes and the correct sequencing.

💡Combination Codes

Combination codes in ICD-10-CM are used to identify two or more conditions with a single code. These codes are used instead of listing separate codes for each condition when the conditions are commonly associated or occur together. The video script emphasizes the importance of using combination codes when applicable to ensure accurate and efficient coding.

💡Unspecified Codes

Unspecified codes in ICD-10-CM are used when the documentation is not specific enough to assign a more detailed code. These codes are often used as a last resort when a more precise diagnosis cannot be determined from the available clinical information. The video script explains the appropriate use of unspecified codes in medical coding.

💡Syndromes

A syndrome in medical terms is a group of signs and symptoms that occur together and are characteristic of a particular abnormality or condition. Syndromes are important in medical coding because they may have specific ICD-10-CM codes that encompass the entire set of related signs and symptoms.

💡Complications of Care

Complications of care refer to conditions that arise as a result of medical treatment or procedures. In medical coding, it is crucial to document and code these complications accurately to reflect the patient's clinical picture and for billing purposes. The video script explains that the healthcare provider must link the complication to the care provided, and it is not the coder's role to make this determination.

Highlights

Review of ICD-10-CM conventions and general coding guidelines.

Explanation of the difference between medical coders and medical billers.

Discussion on the importance of following guidelines in ICD-10-CM coding.

Overview of the 19 conventions in Section 1A of ICD-10-CM.

Detailed explanation of NOS (Not Otherwise Specified) and NEC (Not Elsewhere Classifiable) codes.

Use of abbreviations, punctuation, and symbols in ICD-10-CM coding.

Guidelines for coding signs and symptoms that are integral or not integral to a disease process.

Instructions on coding acute and chronic conditions and their proper sequencing.

Explanation of combination codes and their usage in ICD-10-CM.

Coding for sequela or late effects of a disease or condition.

Guidelines on coding for healthcare encounters in the aftermath of hurricanes.

Importance of verifying codes in the tabular list after looking them up in the alphabetic index.

Quizzes and scenarios provided to test knowledge and bring coders closer to ICD-10-CM coding mastery.

Discussion on the use of 'and' and 'or' in ICD-10-CM and their implications for coding.

Explanation of the role of laterality in coding and how it is determined in ICD-10-CM.

Overview of general coding guidelines Section 1B, including instructions on coding to the highest level of specificity.

Transcripts

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