Table of Contents

 

 

 

 

Preface

viii

 

Objectives

viii

 

Organization of the Workbook

viii

Chapter 1

Overview of Coding

1

 

Assignment 1.1 - Career as a Coder: Interview of a Coding Professional

1

 

Assignment 1.2 Professional Discussion Forums (LISTERV)

2

 

Assignment 1.3 Coding Overview: Validating Accuracy of ICD Codes

3

 

Assignment 1.4 Health Data Collection: Face Validity of Data Management Reports

3

 

Review

5

Chapter 2

Introduction to ICD-9-CM Coding

9

 

Assignment 2.1 - ICD-9-CM Index to Diseases

9

 

Assignment 2.2 ICD-9-CM Index to Procedures

10

 

Review

10

Chapter 3

ICD-9-CM Coding Conventions

13

 

Assignment 3.1 - Applying ICD-9-CM Coding Conventions

13

 

Review

19

Chapter 4

ICD-9-CM Coding Guidelines

21

 

Assignment 4.1 - ICD-9-CM Official Guidelines for Coding and Reporting

21

 

Assignment 4.2 - ICD-9-CM Disease Coding

22

 

Assignment 4.3 - ICD-9-CM Procedure Coding

28

 

Review

33

Chapter 5

ICD-9-CM Hospital in Patient Coding

35

 

Assignment 5.1 - Physician Query Process

35

 

Assignment 5.2 - Selecting and Coding Principal Diagnosis, Other (Additional) Diagnoses, Principal Procedure, and Other Significant Procedures

38

 

Assignment 5.3 - Coding Practice: Hospital Inpatient Cases

43

 

Review

54

Chapter 6

ICD-9-CM Outpatient and Physician Office Coding

57

 

Assignment 6.1 - Physician Query Process

57

 

Assignment 6.2 - Diagnostic Coding and Reporting Guidelines for Outpatient Services: Hospital-Based and Physician Office

60

 

Assignment 6.3 - ICD-9-CM Coding Guidelines for Outpatient Diagnostic Tests

61

 

Assignment 6.4 - Selecting the First-Listed Diagnosis and Linking Diagnoses With Procedures/Services for Medical Necessity

62

 

Assignment 6.5 - Coding Practice

63

 

Review

71

Chapter 7

HCPCS Level II National Coding System

75

 

Assignment 7.1 - HCPCS Level II Index

75

 

Assignment 7.2 - HCPCS Level II Modifiers

76

 

Assignment 7.3 - Assigning HCPCS Level II Codes

76

 

Assignment 7.4 - Coding Practice

80

 

Review

82

Chapter 8

Introduction to CPT Coding

85

 

Assignment 8.1 - CPT Index

85

 

Assignment 8.2 - CPT Appendices

87

 

Assignment 8.3 - CPT Symbols

94

 

Assignment 8.4 - CPT Sections, Subsections, Categories, and Subcategories

96

 

Assignment 8.5 - CPT Modifiers

97

 

Review

100

Chapter 9

CPT Evaluation and Management

103

 

Assignment 9.1 - Levels of Evaluation and Management Services

103

 

Assignment 9.2 - Assigning Evaluation and Management Codes

106

 

Assignment 9.3 - Coding Practice

108

 

Review

110

Chapter 10

CPT Anesthesia

115

 

Assignment 10.1 - Determining Anesthesia Service Payments

115

 

Assignment 10.2 - Anesthesia Modifiers

117

 

Assignment 10.3 - Coding Practice

120

 

Review

124

Chapter 11

CPT Surgery I

127

 

Assignment 11.1 - Coding Practice

127

 

Assignment 11.2 - Coding Operative Reports

127

 

Review

129

Chapter 12

CPT Surgery II

133

 

Assignment 12.1 - Coding Practice

133

 

Assignment 12.2 - Coding Operative Reports

134

 

Review

137

Chapter 13

CPT Surgery III

141

 

Assignment 13.1 - Coding Practice

141

 

Assignment 13.2 - Coding Operative Reports

142

 

Review

145

Chapter 14

CPT Surgery IV

149

 

Assignment 14.1 - Coding Practice

149

 

Assignment 14.2 - Coding Operative Reports

151

 

Review

157

Chapter 15

CPT Surgery V

159

 

Assignment 15.1 - Coding Practice

159

 

Assignment 15.2 - Coding Operative Reports

163

 

Review

169

Chapter 16

CPT Radiology

171

 

Assignment 16.1 - Coding Practice

171

 

Assignment 16.2 - Coding Radiology Reports

174

 

Review

179

Chapter 17

CPT Pathology and Laboratory

181

 

Assignment 17.1 - Coding Practice

181

 

Assignment 17.2 - Coding Pathology and Laboratory Reports

183

 

Review

188

Chapter 18

CPT Medicine

191

 

Assignment 18.1 - Coding Practice

191

 

Assignment 18.2 - Coding Medicine Reports

192

 

Review

194

Chapter 19

Insurance and Reimbursement

197

 

Assignment 19.1 - Chargemaster Review Process

197

 

Assignment 19.2 - Interpreting a Remittance Advice

199

 

Assignment 19.3 - Interpreting a Medicare Fee-For-Service Payment Error Report

199

 

Assignment 19.4 - Ambulatory Payment Classifications

202

 

Assignment 19.5 - Interpreting Diagnosis-Related Groups Decision Trees

203

 

Assignment 19.6 - Assigning Diagnosis-Related Groups

207

 

Assignment 19.7 - Resource Utilization Groups

210

 

Review

214

 

APPENDICES

219

Appendix A

Ambulatory Surgery Unit Coding Cases (ASUCase001-010)

219

Appendix B

Emergency Department Coding Cases (EDCASE001-010)

259

Appendix C

Physician Office Coding Cases (POCase001-010)

283

Appendix D

Inpatient Coding Cases (IPCase001-010)

305

Appendix E

Mock Certified Professional Coder (CPC) Certification Examination

581