ASGE Annual GI Advanced Practice Provider Course (Virtual) - Onboarding Day One

13_Billing_Coding - Olmstead

Pdf Summary

The document discusses various aspects of billing and coding in healthcare. It emphasizes the importance of accurately representing the clinical scenario through coding specificity. The document states that coding systems are used to translate services performed and expected payment. It mentions the AMA/CPT codes for procedures and the HCPCS codes for healthcare services. The document also briefly introduces ICD-10 diagnosis codes and the different chapters included in the ICD-10CM Tabular List.<br /><br />The document explains the principles of diagnosis coding, including the importance of coding to the highest specificity and coding all relevant conditions that impact clinical decision-making. It provides examples of different diagnosis codes related to various conditions.<br /><br />The document goes on to discuss the evaluation and management codes for different types of patient visits. It explains the components that determine the level of service, including the chief complaint, history, physical examination, and medical decision-making. It mentions the changes in coding guidelines from 1995/1997 to 2021 and the new criteria for coding based on total time.<br /><br />The document also touches on coding for social determinants of health and provides examples of ICD-10CM codes related to housing and economic circumstances, environmental exposures, food insecurity, transportation difficulties, interpersonal violence, and lack of social support.<br /><br />The document concludes with some suggestions for optimizing coding practices, such as developing visual cues, templates, and workflows, and conducting coding team reviews and peer-peer clinical documentation reviews.<br /><br />Overall, the document provides a brief overview of billing and coding in healthcare, covering different coding systems, diagnosis coding principles, evaluation and management codes, and considerations for coding social determinants of health.

Keywords

billing

coding

healthcare

clinical scenario

coding specificity

services performed

expected payment

diagnosis coding

patient visits

social determinants of health