LWW S Administrative Medical Assisting (Fourth Edition)

LWW’s Administrative Medical Assisting (Fourth Edition)

Chapter 11 — Diagnostic Coding

Lippincott Williams & Wilkins’ Administrative Medical Assisting (Fourth Edition)Lesson Plans

Part II. The Administrative Medical Assistant

Unit Three: Managing the Finances in the Practice

Chapter 11 — Diagnostic Coding

Name______Date ______

Estimated Time: 30 minutes

Figures, Tables, and Features

Resources and

In-Class Activities

Instructor’s Notes

Content / Competency / Text / PPt
Diagnostic Coding
Inpatient Versus Outpatient Coding / CAAHEP Standard: Medical Business Practices, IX.C.IX. Procedural and Diagnostic Coding. 2. Describe how to use the most current diagnostic coding classification system / 269-270 / 10-17 / In-Class Activities:
Read/Discuss “Legal Tip”: Does Everyone Need to Know?, p. 269.
Bring several copies of the ICD-9-CM and/or ICD-10-CM to class and allow students to browse them. If you do not have code books, contact your local medical offices. Codebooks have to be updated each year, and staff are usually happy to pass on outdated books to educational institutions.
Case study, p. 268
Resources:
World Health Organization

U.S. Department of Health and Human Services

Centers for Medicare and Medicaid Services

American Health Information Management Association

Legend: SR: Student Resources on thePoint; IR: Instructor’s Resource Center on thePoint; PPt: PowerPoint; SG: Study Guide.

Outside Assignments/Evaluation:

Checkpoint Question 1: What is meant by medical necessity?

Checkpoint Question 2: What organization must approve any changes in the disease classification system?

Checkpoint Question 3: Name and give uses for the three volumes of the ICD-9-CM.

Name______Date ______

Estimated Time: 45 minutes

Figures, Tables, and Features

Resources and

In-Class Activities

Instructor’s Notes

Content / Competency / Text / PPt
The Diagnostic Codebook
Tabular List of Diseases
Alphabetic Index to Diseases
Inpatient Coding / CAAHEP Standard: Medical Business Practices, IXIC.IX. Procedural and Diagnostic Coding. 2. Describe how to use the most current diagnostic coding classification system / 270-274 / 18-34 / Fig. 11-1: Table of contents from ICD-9-CM, Volume 1 and ICD-10-CM, p. 271.
Fig 11-2: Sample page from ICD-9-CM, Volume 1, showing categories, subheadings, and so on, p. 272.
Table 11-1: ICD-9-CM Appendices, p. 273.
Box 11-1: Tips Regarding Personnel Manuals, p. 274. / In-Class Activities:
Invite a professional medical coder to give a presentation to the class. Have the students prepare questions ahead of time.

Legend: SR: Student Resources on thePoint; IR: Instructor’s Resource Center on thePoint; PPt: PowerPoint; SG: Study Guide.

Outside Assignments/Evaluation:

Checkpoint Question 4: How often is the ICD-CM updated? When is the use of the new codes required?

Checkpoint Question 5: List four reasons for using E-codes.

Checkpoint Question 6: What are supplementary codes to classify Factors Influencing Healh Status used for?

Name______Date ______

Estimated Time: 50 minutes

Figures, Tables, and Features

Resources and

In-Class Activities

Instructor’s Notes

Content / Competency / Text / PPt
Locating the Appropriate Code
Using the Diagnostic Coding Conventions
Main Term
Additional Digits
Primary Codes
When More Than One Code Is Used
Coding Suspected Conditions
Documentation Requirements / ABHES Competencies:
Medical Office Business Procedures,
t. perform diagnostic and procedural coding.
CAAHEP Standard: Medical Business Practices, IX.C.IX. Procedural and Diagnostic Coding. 2. Describe how to use the most current diagnostic coding classification system
CAAHEP Standard: Medical Business Practices, IXIC.IX. Procedural and Diagnostic Coding. 5. Define medical necessity as it applies to procedural and diagnostic coding.
CAAHEP Standard: Medical Business Practices, IX.P.IX. Procedural and Diagnostic Coding. 2. Perform diagnostic coding
CAAHEP Standard: Medical Business Practices, IX.P.IX. Procedural and Diagnostic Coding. 3. Utilize medical necessity guidelines.
CAAHEP Standard: Medical Business Practices, IX.A.IX. Procedural and Diagnostic Coding. 1. Utilize tactful communication skills with medical providers to ensure accurate code selection. / 274-280 / 35-47 / Box 11-2: CMS Diagnostic Coding Guidelines, p. 275.
Fig. 11-3: Conventions used in diagnostic coding, p. 276.
Fig 11-4: Samples of fifth-digit classifications from ICD-9-CM, p. 277.
Fig. 11-5: Samples of seventh-digit classification from ICD-10, p. 278.
Fig 11.6: Sample CMS-1500 claim form indiciating proper sequencing. P. 279
Fig 11-7: Sample section of late effects in ICD-9-CM, p. 280. / In-Class Activities:
Read/Discuss “What If?’ p. 275.
Read/Discuss “Legal Tip”:Don’t Give Patients a Disease They Don’t Have!, p. 278.
Read/Discuss “Ethical Tip”:
Don’t Break the Rules, p. 281.
Procedure 11-1: Locating a Diagnostic Code, p. 285.
Warm-Ups for Critical Thinking question 1:
Tom Barksdale has been seen by the physician for controlled non–insulin-dependent type 2 diabetes mellitus for about 10 years. While being seen for a routine check of his blood sugar, he complains of numbness and tingling in his left lower leg and foot. An x-ray of both legs is performed because poor circulation in the extremities can be a complication of diabetes. The x-ray confirms the diagnosis of peripheral neuropathy. Which ICD-9 code should be listed with the office visit? Which code indicates the reason for the x-ray? Which code should be placed on the CMA-1500 first as the primary diagnosis or reason for the visit?
Warm-Ups for Critical Thinking question 2:Determine the main term for the following multiple word diagnoses: gestational diabetes; amyotrophic lateral sclerosis; benign, localized hyperplasia of prostate; and nursemaid’s elbow.
Warm-Ups for Critical Thinking question 3:A patient calls complaining of pain and swelling in the right hand since awakening this morning. The patient comes in, sees the doctor, and returns to the front desk with an encounter form that states his diagnosis is “gout.” In order to make this diagnosis, the physician would need to know the patient’s uric acid level. You know that the patient just had blood drawn for the test. It is a test that must be sent to an outside lab. Do you still code today’s visit as “gout”? What would you do?

Legend: SR: Student Resources on thePoint; IR: Instructor’s Resource Center on thePoint; PPt: PowerPoint; SG: Study Guide.

Outside Assignments/Evaluation:

Checkpoint Question 7: When coding a visit on a date before a definitive diagnosis is made, what is coded?

Competency Evaluation Form for Procedure 11-1
Name______Date ______

Estimated Time: 30 minutes

Figures, Tables, and Features

Resources and

In-Class Activities

Instructor’s Notes

Content / Competency / Text / PPt
The Future of Diagnostic Coding: International Classification of Diseases, Clinical Modification, Tenth Revision
Conventions
Placeholder "X"
Special Codes / CAAHEP Standard: Medical Business Practices, IX.C.IX. Procedural and Diagnostic Coding. 2. Describe how to use the most current diagnostic coding classification system / 280-282 / 48-53 / Box 11-3: Diabetes Mellitus Codes in ICD-10, p. 282. / In-Class Activities
EMR activity, p. 283

Legend: SR: Student Resources on thePoint; IR: Instructor’s Resource Center on thePoint; PPt: PowerPoint; SG: Study Guide.

Outside Assignments/Evaluation:

Checkpoint Question 8:How will the implementation of ICD-10-CM improve the coding of reasons for services?