Coding and Reimbursement: A Tutorial

ABSTRACT

This discussion is a brief overview and tutorial of rationales for accurate selection of procedure (CPT) and diagnosis (ICD-9-CM) codes. The CPT selection procedure is very stringent and is contingent upon finding the code descriptor that describes precisely what was performed. In contrast to the magnitude of precision of the CPT codes, the ICD-9-CM system is incomplete with regard to coding options. For diagnosis code selection, the provider must choose a code that is as close as possible to the evaluation's diagnostic conclusion and patient status. Also included in this tutorial is a brief discussion of the documentation requirements to justify and support the particular codes that were selected.

KEYWORDS

Reimbursement - coding - ICD-9-CM - Resource Based Relative Value System - Current Procedural Terminology - Health Care Economic Committee - HCFA Common Procedure Coding System - HIPPA

REFERENCES

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