Medical coding study guide

International Classification of Diseases, Ninth Revision, Clinical Modification
Main terms
represents diseases, injuries, problems, complaints, drugs, and external causes of diseases or conditions
words that are identified under main term
indented 3 character spaces from the term above it
reports circumstances other than disease or injury
Tabular List (3) divisions
diagnoses codes, supplementary classification, appendixes
E- codes
Supplementary Classification of External Causes of Injury and Poisoning. These codes classify the causes of injury, poisoning, and adverse events and are used to gather statistics relating to these occurences.
ICD-9-CM codes range
3 to 5 digits
Tabular List Format
Chapter, Section, Category, Subcategory, Subclassification,
Alphabetic Index is
Vol. 2, contains medical terms and is used first
Tabular List is
Vol. 1
Alphabetic Index lists words describing
pneumonia, bronchitis, infection, and fracture
External causes of diseases
fall, accident, burn, and cut
Category codes are
3 digits
Subcategory codes are
4 digits
Subclassification codes re
5 digits
Classifies procedures used in hospitals only
Vol. 3
Basic coding
Review complete medical documentation and Abstract the
medical conditions and procedures that should be coded
parenthetical or nonessential modiers, terms surrounded by parentheses
terms see, see also, and see category. Coder must look elsewhere
HIPPA Final Rule
in addition to mandating the ICD-9-CM code set, also requires the use of ICD-9-CM Official Guidelines for Coding and Reporting, when codes are selected
are used to enclose synonyms, alternative wordings, ans explanatory phrases in the tabular list of diseases and injury
used in Alphabetic Index and Tabular Lists to enclose terms that are supplementary, that may or may not be present in the disease statement, and that do not affect code assignment. They are always used to enclose nonessential terms
section mark
precedes a code to indicate there is a footnote with special instructions. Found in all 3 volumes
used to identify main terms and titles in the Alphabetic Indexes. Depicts each code and code title in Tabular List
Code first underlying disease
located only in Tabular List with codes that are not intended to be selected as a primary disease because they are manifestations of other underlying disease. Sometimes in italics
HIPPA legislation
requires the use of ICD-9-CM for reporting diagnoses in all patient care settings and also stipulates the Official Guidelines
Current Procedural Terminology
CPT is maintained by
American Medical Association (AMA)
CPT was designated
by Federal Dept of Health and Human Services(HHS) as nationally accepted HIPPA standard code set for physician and other health care professional services
Category 1 codes
are permanent CPT codes
6 sections of category 1 codes
Evaluation and Management, Anesthesia, Radiology, Surgery, Pathology and Lab, and Medicine
Surgery section
Largest procedure code section, with codes ranging from 10021-69990
separate procedure
CPT explains that it can be reported if it was performed alone, for a specific purpose, and independent of any other related service provided. If it was performed as a component part of a larger procedure it is not billed separately.
Appendix A
List of Modifers
Appendix C
Clinical Examples
Appendix E
Summary of CPT codes exempt from Modifer -51
if a physician bills and is paid the full amount on the fee schedule
Always list
the modifer that affects payment first, where there are multiple modifiers
Modifier -21
Not a facility modifier
Physicians bill medical services and procedures on
Never make a code
HCPCS code set
if a code cannot be found that matches what was done
Category 3 code section
If HCPCS does not include a code that fits or if the payer does not accept HCPCS codes