·- -
in g : /CD 1 0 a n d 11
_,,
and Co d
.,.
0 Medical Bil
ling
rogress 100%
Module 1 P
O u t c o m e s
Learning
will be a b le to:
this module, you
pleted
Having com
a n d b e n efits of
g n is e t h e purpose
• Reco 1 O c o de set
D -
t in g t h e IC
im p le m e n n of the
a n i s a t i o
s t r u c t u r e and org
e
• D e s c r ib e t h
e set
ICD-1 O c o d
• g g u i d e l i nes and
h e s p e c ific codin
I d e n t if y t
ju r ie s , e x ternal
t io n s f o r c o d i n g in
conven
a n d c o m plications
causes,
r y a n d s e condary
is h b e t w e en p r i m a
• Distingu i n g t e c h n iques
s e s a n d a pply c o d
diagno
a c c o r d in g ly
c t ic e s f o r c li n ic a l
x p lain t h e best pra n t With
• E e a l i g n m e
e n t a t io n t o ensur
docum
d in g r e q u ir e m e n t s
co
5:59
~ Q
s Medical Billing and Coding: ICD 10 and 11 0
Module 1 Progress 100%
ICD-1 Ocoding conventions are rules and guidelines
that dictate how codes should be used and
interpreted.
Definitive Diagnosis refers to a medical conclusion
regarding the nature and cause of illness in a
patient, confirmed by examination, testing or other
forms of investigative procedures.
hen a clear diagnosis has not been determined,
signing codes for the symptoms and signs is
I
propriate. This method ensures an accurate
representation of the patient's current healthcare
needs.
Ill-defined conditions are those that are vaguely or
incompletely described. They are frequently found
in medical documentation, especially in emergency
departments or when dealing with complex cases.
XP 170 Next )
5:59
A
s Medical Billing and Coding: ICD 10 and 11 0
Module 1 Progress 100%
ICD-1 o Codebooks are the definitive guides to
understanding, exploring, and correctly applying
ICD-1 O codes. The codebook is divided into three
major parts:
Tabular List: This part comprises the 22
chapters of ICD-1 Ocodes. Each chapter contains
a set of blocks with related conditions, which are
further broken down into categories and
~
subcategories, all providing increasing levels of
specificity.
~ Alphabetic Index: This is an alphabetical listin
I
of terms and their corresponding codes. It's an
efficient way to look up codes based on
conditions or symptoms.
Guidelines: This is where you will find the rules
for using the classification system. It includes
general rules that apply to the entire
classification, as well as chapter-specific
guidelines that provide specific coding
instructions for certain categories.
ICD-10 coding conventions are rules and guidelines
that dictate how codes should be used and
- . - -.
XP 170 )
Next >
I . ' . I • I t
: D 1 0 a n d 11
0
...
0 Medical Billing a n d Coding IC
ss 1 0 0 %
Module 1 Progre
im a l p o in t, a n d finally,
digits, a d e c
followed b y tw o re a ll o w s fo r
. T h is s tru c tu
digits
one o r tw o m o re n o f m e d ic a l
d o rg a n is a ti o
precise classific
ation a n
data .
IC D -1 0 c o d es into chapters
o f the
The organisation n s a ll o w s fo r
o r c o n d it io
ystems
based on body s o f a p p ro p ri a te
ti fi c a ti o n
and iden
easier navigation
c h a p te rs in IC D-10, e a c h
22
codes . There are
t c a te g o ry o f d is e a s e s o r
representing a d
ifferen
-- alth-related cond
ition s . E a c h c h a p te r is fu rt h e r
f s im il a r
< ided in to b lo c k s th
a t co n ta in a g ro u p o
conditions.
d o rg a nis a ti o n c o n tr ib u te to
ture an
The ICD-10 struc s e n ti n g various
ra te ly re p re
in a c c u
it s effectiveness il le d m e d ic a l
c o m e a s k
n. To b e
health informatio tr u c tu re a s th e
e n d th is s
c o m p re h
coder, it is vital to
initial s te p .
Module 1 Progress 100%
Lesson Summary
The key points from this module are:
es {ICD) is
The International Classification of Diseas
h
a system developed by the World Healt
and code all
Organization {WHO). It aims to classify
d health
diseases, disorders, injuries, and relate
~
conditions.
e International Classification of Diseases
ces its origins back to the 19th century
(ICD)
when th
I
~
s adopted
International List of Causes of Death wa
by the International Statistical Institu
te in 1893.
ss where
Medical billing and coding is the proce
nt care
healthcare professionals convert patie
codes e-
de tai ls int o alphanumeric codes. These
cedures, and
nc om pa ss diagnoses, treatments, pro
even equipment used during care.
ination of
The ICD-1 O co din g system uses a comb
with a letter,
let ter s and numbers. Each code sta rts
.. . ..... .. ..
, and finally,
fol low ed by tw o digits, a decimal point
- -
- -
Next >
·
g a n d Coo,,•~
Bill i n
..,,,
0 M edical
s 100% t ailed
res d e f
d u l e 2 Prog p e cific ,
n c ept o
M o r e s c o
o f f e r ing mo o d u c es the entity
o d e s , o i n t r i n g l e
c ls ws a s
i o n. It a l o
i c a t h a l if it's
classif , w h i c o r i e s
l e p a renting l t i p l e categ
multip e d into m
u
lass i f i
to be c T h e ICD-
relevan
t.
i n i tions:
a s e D e f
s e s and
is e e a
y and D e w er dis
Termin
o l o g
d e s o me n
s e a s es are
u i
e s n ot incl i t i o ns of
d
l
1o d o
o m e def i n
n t m edica
ions. S n curr
e eases
condit s e d o w d i s
o u t d ated b
a
i n c l u des ne f o pmen
a l s o - 1 1 de v e
t a n d i ng. fCD s i n c e the of ma
u n d e r s n t i f i e d t i o n s
o ns ide defini
n d i t i e s t h e nts in
and co u p d a t c e m e
- 1 O . It also d o n advan
o f ICD
e a s e s base
g di s
e x i s t i na l s c i e n c e . g h it has
me d i c h o u
/ C D - 10, alt o r paper
-
h e d f
o logy: T e signe
e o f T
_ ~ ~ h n
r i g i n a l l y d
s i g n ed for
Us o e
d, Was 1 is d
e e n d 1 g 1 t 1 s e
i l e t h e / C D - 1
a n d i nctud es
b h tronic
~ Y s t ems, W y e l e c
base~ a g e _ I t i s f u l lt o . d - s e l e ction
1ta/
the_ d1gr f a c e d e s i g
ned
a , •n Code
an inte c a tion.
p p l i
and a
'-'
il li n g a n u
M e d ic a l B
u le 2 p r o g ress 1 0 0 %
Mod
n ( W H O ) re/eased
o
H e a lt h organizati
The wor ld
e I n t e r n a t io n a l
h e 1 1 t h r e v is io n o f t h
1co-11, t , in J u n e 2 0 1 B.
s e s
ic a t io n o f Disea
c la s s if
r t h e d ig it a l h e a lt h
s b e e n d e s ig n e d f o
The ,co-11
h a
t im p r o v e m e n t s in
n
; n t r o d u c e s s ig n if ic a u s e r - f r ie n d ly ,
era . I t m o r e
n d u ti li ty , m a k in g it
structure a a ll y r o b u st, and
a n d s c ie n t if ic
opera ti o n a ll y
e s in h e a lt h c a r e .
b le t o f u t u re advanc
adapta D-1 o
e n c es b e t ween IC
key d i f f e r
7 10w are some
~ d IC D - 1 1 :
ICD-1 O c o
des are seven
S t r u c t u r e : e o
Coding s is t o f t h r e t
t
r ic and c o n s is t of
a lp h a n u m e
co d e s c o n .
r s . T h e IC D - 1 1
t ear ss e m
c harac te . r a c
p t o t o u r a l p h a n u m e r ic c h a ,
c ohd. eho f u
w u p t o t
y
m a y b e f o ll o w e d b
ic
t e n s io n c o d e s. w o
r ic e x
a lp h a n u m e
u r e a n d D e t -,1s : T h e I C D - 1 0
n S t r u ctt I a
.Classif icatio pro x im codes ,
includes a p 0 0 u n iq u e
IC D - 1 1 b a e y 1o4v,e4 5 5
w h il e t h e oasts e
r , 0 0 0 u n iq u
r in g m o r e s p e ·fi
codes, o f f e C l IC
d
, d e t a il e o n c e p t o f
s s if ic a t io n . I t a/s o .in . t r o d uces th e c
c la . .
Next )
I XP 1 7 0 )
·- -
s Medical Billing and Coding: ICD 10 and 11 0
Module 1 Progress 100%
Cultivate a Strong CDI Team: An effectiv e CDI
team often includes professionals from various
disciplines, such as health informa tion
management (HIM) professionals, coders,
nurses, and physicians.
Continuous Education and Training: Regular
education and training are crucial for keeping the
CDI team abreast of changes in guidelines,
regulatory requirements, and coding practices.
~
~
Develop a Query Process: A query process is a
method of clarifying and obtaining missing,
unclear, or conflicting informa tion from provid
I
for coding purposes. The process should be
standardised, ensuring that all queries are
consistent, non-leading, and complia nt with
guidelines set by professional organisations like
AHIMA (the American Health Information
Management Association).
Regular Audits: Regular audits can identify
documentation gaps and areas for improvement.
The results of these audits can guide training
efforts and help measure the success of your
CDI program over time.
XP 170 Next >
s Medical Billing and Coding: ICD 1 O and 11
0
Module 1 Progress 100%
External causes refer to the environmental events I
circumstances, or conditions that caused the injury
or health condition. They are coded using the V00-
ygg range in the ICD-10 code set.
Complications are defined as issues that directly
result from disease, procedure, treatment or injury.
~
~
Understanding the principles and best practices of
nical documentation will enhance your ability
curately interpret and code patient records,
ti
leading to improved data quality and financial
outcomes for healthcare providers.
Clinical Documentation Improvement, or CDI, is a
process used in healthcare to ensure clinical
documents are accurate, comprehensive, and
support compliant coding and reporting . Below
are some strategic methods to implement a
successful COi program:
Cultivate a Strong CDI Team: An effective COi
team often includes professionals from various
disciplines, such as health information
1 XP 170 1 Next >
e Med ical Billing and Coding : ICD 10 and 11
0
Mod ule 2 Progress 100%
,
Outpatient services, also called ambulatory care
done
are medical procedures or tes ts tha t can be
with out an overnight stay. Patients visi t for
treatment and return home the same day.
t
Inpatient care involves receiving trea tme nt tha
typ e
requires admission into a hospital. During this
,
of care, patients stay for an extended period
J
ranging from several days to weeks, to receive
cessary medical services.
the
I
t aids
An encoder is a specialised sof twa re too l tha
coders in finding and validating codes. It's
harged
essentially an electronic coding boo k superc
and
with interactive features to improve efficiency
accuracy.
Electronic Health Records (EHRs) are digital
rt,
versions of a patient's trad itio nal paper cha
s
offe ring real-time and patient-centric record
ise d
accessible instantly and securely by aut hor
users.
XP 170 j Next )
6:01
~ Q
s Medical Billing and Coding: ICD 10 and 11 0
Module 2 Progress 100%
p p • y I I
depict complex health conditions.
The updates and enhancements in ICD-11
revolutionise the way we approach medical coding.
They promise more precision, usability, and
adaptability to future changes in the healthcare
landscape.
~
~
ICD-11 has made significant progress by including
w conditions that arose after ICD-1 O was
plemented. This update is a result of
I
advancements in medical science and our improved
understanding of various health conditions.
Comorbidity refers to the simultaneous presence of
additional conditions alongside a primary condition.
For example, a patient may be diagnosed with heart
disease while also having diabetes and
hypertension.
XP 170 Next )
.
0 Medical Billing and coding: !CD 1Oand 11
Module 2 Progress 100%
The structure of ICD-11 marks a significant
enhancement over ICD-1 O. The ICD-11 code set
follows a systematic structure which includes:
Stem Codes: These are the base codes in ICD-11
that describe specific health conditions. They are
up to four characters long and can include both
numbers and letters.
Extension codes: These are designed to provide
~ additional information about the health conditil
~ being coded. These codes can be added to the
stem code to offer more detail about severity,
anatomical location, aetiology, and other aspects
of the condition.
Cluster Coding: This novel feature in ICD-11
allows multiple codes to be linked together to
represent complex clinical situations. This
feature improves upon the ability of ICD-1 oto
depict complex health conditions.
The updates and enhancements in ICD-11
revolutioni~e the way we approach medical coding.
They promise more precision, usability, and
XP 170 i Next )
Module 2 Progress
1OO%
Integrating EHR and co
ding is essential for
accurate documentatio
n, code assignment, and
medical billing . Coding
within EHRs is often
facilitated by Compute
r-Assisted Coding (CAC
)
systems, which autom
atically generate a set of
medical codes for revi
ew based on the clinical
documentation within
the EHR.
In medical coding, stan
ormation exchange. S
-----.::a_,,mmunication betw
dardisation is essentia
sure the accurate, relia
l to
ble, and efficient health
tandards allow for bette
r
I
een healthcare systems
and
settings, making intero
perability possible.
systematized Nomencl
ature of Medicine Clinical
Terms (SNOMED CT) is
one of the world's most
comprehensive, multilin
gual clinical healthcare
terminologies. It provides
a common language that
enables a consistent way
of indexing, storing,
retrieving, and aggregat
ing clinical data across
specialities and care site
s.
1 XP170 )
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