CPT Procedural Codes

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Week 1 Discussion Thread
Part 1: Discuss the necessity of understanding the interaction of the CPT procedural codes and the ICD diagnostic codes.

In order to understand the interaction of the CPT procedural codes and ICD diagnostic codes it is important to know the function for individual codes.

CPT procedural codes a series of numbers, usually five digits long. They are used to identify medical services and procedures performed by physicians as well as for other diagnostic services. They are a language of communication with third party insurance payers.

ICD codes are codes used in assigning a number to describe thousands of possible diseases, as well as traumatic, social and environmental circumstances leading to bodily harm.

Part …show more content…
Report all healthcare data elements (e.g. diagnosis and procedure codes, present on admission indicator, discharge status) required for external reporting purposes (e.g. reimbursement and other administrative uses, population health, quality and patient safety measurement, and research) completely and accurately, in accordance with regulatory and documentation standards and requirements and applicable official coding conventions, rules, and guidelines.
3. Assign and report only the codes and data that are clearly and consistently supported by health record documentation in accordance with applicable code set and abstraction conventions, rules, and guidelines.
4. Query provider (physician or other qualified healthcare practitioner) for clarification and additional documentation prior to code assignment when there is conflicting, incomplete, or ambiguous information in the health record regarding a significant reportable condition or procedure or other reportable data element dependent on health record documentation (e.g. present on admission indicator).
5. Refuse to change reported codes or the narratives of codes so that meanings are …show more content…
Demonstrate behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities.
(AHIMA Standards of Ethical Coding. (n.d.). Retrieved from http://bok.ahima.org/doc?oid=106344#.WG7mVxsrLIU)

Unethical Coding Practice:

1. Query the provider when there is no clinical information in the health record prompting the need for a query. Example:
Query the provider regarding the presence of gram-negative pneumonia on every pneumonia case, regardless of whether there are any clinical indications of gram-negative pneumonia documented in the record.

2. Refuse to change reported codes or the narratives of codes so that meanings are misrepresented.
Coding professionals shall not:
Change the description for a diagnosis or procedure code or other reported data element so that it does not accurately reflect the official definition of that code.
Example:
The description of a code is altered in the encoding software, resulting in incorrect reporting of this code.
3. Refuse to participate in or support coding or documentation practices intended to inappropriately increase payment, qualify for insurance policy coverage, or skew data by means that do not comply with federal and state statutes, regulations and official rules and
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