Medical Billing and Coding Online

Medical Billing & Medical Transcription

Job opportunities for professionals in the healthcare industry are on the rise across the United States, with medical billing and medical transcriptionists in high demand. This increase correlates directly to the 60 million plus baby boomers and more than 1,500 healthcare plans now available to cover the aging U.S. population. 
 
<h2>Medical Billers vs Medical Transcriptionists</h2>When researching careers in medical billing or medical transcription, you'll likely find certain similarities-both of these jobs usually require staff to work in a doctor's office, hospital, medical center or dentist's office, and both of these professions require knowledge of medical terms. That, however, is usually where the similarities end. The two professions have distinct roles that are often confused. The following is a quick reference guide outlining the differences between medical billers and medical transcriptionists. 
 
<H3>Medical Billers Duties</H3>A medical biller manages the processing of medical bills in doctor's offices, medical centers, 
hospitals, etc. It is the duty of a medical biller to transmit the claim (medical procedure and diagnosis codes) to the payer (insurance). Typically, this information is transmitted electronically. 
 
<H3>Medical Billers Job Skills</H3>A successful medical billers must understand medical terminology (including jargon and abbreviations), be proficient with computers and understand the latest industry and legal standards. A thorough comprehension of different insurance plans and accompanying governing laws/regulations is also necessary to any adept medical biller. 
 
Typically, post-secondary education is required for medical billing, and degrees are often offered through vocational schools, community colleges, or online training programs offered by online colleges and universities. 
 
<H3>Medical Billers Salary</H3>PayScale.com reports medical billers with one to four years of experience earn an average salary of around $30,000. If they have five to nine years of experience, the average salary is more than $32,000. 
 
<H3>Future Growth Opportunities for Medical Billers</H3>According to the U.S. Department of Labor, the job outlook for the medical billing industry is expected to increase at a rate of four percent. 
 
<H3>Medical Transcriptionist Duties</H3>An employee working in the medical transcription field is generally referred to as a medical transcriptionist or medical transcriber. The main role of a medical transcriptionist is to listen to dictated recordings made by healthcare professionals and subsequently transcribe that information into typewritten formats such as: medical history/physical examination reports, discharge summaries, consultation reports, referral letters, progress notes, operative reports, autopsy reports, and diagnostic imaging studies. These documents are then sent to the healthcare professional for review/signature or correction, after which they become a part of the patient's permanent medical history. 
 
<H3>Medical Transcriptionists Job Skills</H3>To become a successful medical transcriptionist, a working knowledge of medical terminology (including jargon and abbreviations), computer proficiency, and comprehension of current industry and legal standards is required. Post-secondary education is generally required to obtain a medical transcriptionist position, and can be obtained through a career college, community college, or an online course offering. 
 
<H3>Medical Transcriptionist Job Salary</H3>PayScale.com reports the average salary for a medical transcriptionist with one to four years of 
experience is more than $28,000. Medical transcriptionists with five to nine years of experience make on average close to $30,000. 
 
<H3>Medical Transcriptionist Job Future</H3>According to the U.S. Department of Labor, the job outlook for medical transcriptionists looks 
optimistic. Medical transcription jobs are expected to increase by 14 percent between 2006 and 2016.

Medical Billing & Medical Transcription

Understanding Evaluation and Management

Factors Considered in E&M Coding Type of Service: Services covered in the E&M section include, but are not limited to, physician encounters in all locations for "well" or "sick" visits, patient transport, case management services, preventative medicine services and prolonged services. Place of Service: For payment purposes the place of service needs to match the type of service. The places of service are as follows: Office (11) Nursing facility (32) Patient's home (12) Custodial care facility (33) Inpatient hospital (21) Hospice (34) Outpatient hospital (22) Federally qualified health center (50) Emergency department (ED) hospital (23) Inpatient psychiatric facility (51) Ambulatory surgery center (ASC) (24) Partial hospitalization, psychiatric facility (52) Birthing center (25) Community mental health center (53) Skilled nursing facility (SNF) (31) Psychiatric residential treatment center (56) Comprehensive outpatient rehabilitation facility (62) Comprehensive inpatient rehabilitation facility (61) End-stage renal disease treatment facility (65) Other unlisted facility (99) State or local public health clinic (71) Rural health clinic (72) Patient Status. Many of the CPT codes are classified by whether a patient is a new or established patient. A new patient is new to the practice or has not been seen by the specialty in group practice for more than 3 years. An established patient is one who has a continuing relationship with the practice and has been seen within the last 3 years. Levels of E&M Services To understand the levels of history it is important to know the definition and components of the patient's history. The history relates to the patient's clinical picture and depends on the patient for answers to specific questions. The history is composed of the chief complaint, or reason the patient is being seen. This is usually in the patient's own words. The history of present illness (HPI) identifies the location, severity, timing, modifying factors, quality, duration, context and associated signs and symptoms relating to the chief complaint. The review of systems (ROS) has the patient answer questions about the following systems: constitutional, eyes, ear/nose /throat (ENT) and mouth, cardiac, gastrointestinal, muscu¬loskeletal, endocrine, neurological, integumentary, psychi¬atric, genitourinary, allergic/immunologic, respiratory, and hematological/lymphatic. The past medical (PMH), family, and social history (PFSH) is important, because patients' experiences with illness and surgery, whether they smoke, use illicit drugs and/or alcohol, if they are married, have children, where they live, and what diseases their blood relatives have had play an extremely important part in determining their risk factors for illness Now that we understand what makes up the history, the various levels can be discussed. Problem Focused: A problem-focused history con¬centrates on the chief complaint; it looks at the symptoms, severity, and duration of the problem. It usually does not include a review of systems (ROS) or family and social history. Expanded Problem Focused: The physician proceeds the same as for the problem-focused history but includes a review of the systems that relate to the chief complaint. Usually past, family, and social histories are not included. Detailed: The physician will document a more exten¬sive history, ROS, and will document pertinent past, family, and social histories. Comprehensive: The physician will document res¬ponses to all of the components listed previously. A comprehensive history is usually taken during an initial visit with patients who have a significant history of illness. MEDICAL DEDISION MAKING When a physician makes medical decisions, the decisions are based on many years of education and experience. To understand what goes into these decisions, the following guidelines have been developed. NUMBER OF DIAGNOSES/MANAGEMENT OPTIONS. When we read the note the physician writes, we should be able to tell whether the patient's problem is minor or an established problem that is stable or getting worse or whether the patient has a new problem that the physician wants to watch or perhaps to order or perform more tests on. AMOUNT AND COMPLEXITY OF DATA REVIEWED. The physi¬cian's note should tell us what laboratory tests, x-ray diagnostic procedures, and other tests have been ordered or reviewed. RISK OF COMPLICATIONS AND MORBIDITY OR MORTALITY. There is often risk involved in medical care, either from the treatment given to the patient or from the lack of treatment and professional care. Morbidity, the relative incidence of disease, and mortality, which relates to the number of deaths from a given disease, are part of the assessment of risks made by the physician. These three elements play a role in the complexity of the decision-making process used when treating a patient. The physician determines the level of care given to a patient, but must consider these three factors when choosing the E&M levels assigned to a patient on a given encounter. The physician cannot base the choice of E&M levels solely on the time spent with the patient. All elements must be considered when assigning the code. Usually, the physician circles this service code and other procedure codes on the encounter form as or just after the patient is seen in the office. Although a physician may allow the medical assistant to make notations on the encounter form, only the physician makes the decision as to which services and procedures are performed. MEDICAL DECISION-MAKING COMPLEXITY LEVELS Straightforward: Minimal diagnosis/management options, minimal/none for the amount and complexity of data to be reviewed, and minimal risk to the patient of complications or death if untreated. Low-complexity: Limited number of diagnoses/ management options, limited data to be reviewed, and low risk to the patient of complications or death if untreated. Moderate-complexity: Multiple diagnoses/management options, moderate amount and complexity of data to be reviewed, and moderate risk to the patient of complications or death if untreated. High-complexity: Extensive diagnoses/management options, extensive amount and complexity of data to be reviewed, and high risk to the patient for com¬plications and/or death if the problem is untreated. EXAMINATION The examination is the objective part of the patient's visit. The physician examines the patient and makes notes referring to body areas and/or organ systems: Body areas: Head including face and neck, chest, including breasts and axillas, abdomen, genitouri¬nary (GU), back, including spine and extremities. Organ systems: Constitutional, eyes, ears/nose/throat and mouth, cardiovascular, respiratory, gastrointestinal (Gl), GU, musculoskeletal, skin, neurological, psychiatric, and hematological/lymphatic/immunologic. The examination is divided into the following levels: Problem focused: The examination is limited to the single body area or single system mentioned in the chief complaint. Expanded problem focused: In addition to the limited body area or system, related body areas or organ systems are examined. Detailed: An extended examination is performed on the related body areas or organ systems. Comprehensive: A "complete" multi-system examina¬tion is performed. CONTRIBUTING FACTORS Although the determining factors just discussed are the basis for E&M coding, there are circumstances in which other factors contribute to determining the level of service. Counseling. Almost all E&M services contain a degree of counseling with the patient and/or the family. This is factored into the E&M code, and as long as this factor does not exceed 50 % of the time spent with the patient, it is included in the E&M code. Coordination of Care. Some patients need assis¬tance in arranging for care beyond the visit or hospi¬talization. Some will need care in a skilled nursing facility or home health care. Others will need hospice care. The primary physician usually coordinates this care. Nature of the Presenting Problem. The presenting problem is usually explained in the chief complaint. It can range from something as simple as a cold in an otherwise healthy patient to a life-threatening problem. Time. CPT has provided assigned times for each of the CPT E&M codes. Time should not be the determining factor, with one exception: if more than 50 % of the visit is spent counseling, only time determines the level of complexity. PUTTING IT ALL TOGETHER TO DETERMINE THE CODE 1. Determine whether the patient is new or established. 2. Where is the patient being seen-office, hospital, or other setting? 3. Is this a patient of the practice, or is someone requesting a consultation? 4. Is the patient "sick" or here for preventative medicine services? 5. Is the history problem-focused, expanded problem-focused, detailed, or comprehensive? 6. Is the examination problem-focused, expanded problem-focused, detailed, or comprehensive? 7. Is medical decision making straightforward, low, moderate, or high? 8. Pick the code. CPT Coding Definitions Bundled codes describe procedures or services that are grouped together and paid as one. An example would be code 90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine for intramuscular use. Unbundled codes describe separating the components of a procedure and reporting them separately. To use the diphtheria example, if someone reports the three vaccines separately, it gives the impression that three injections rather than one were given. Upcoding is a deliberate increase in a CPT code to receive higher reimbursements. This is a target of CMS investigations and should never be done. Downcoding is usually done by the insurance companies if, on review, the examiner feels the documentation does not match the code description. CRITICAL THINKING APPLICATION If a patient was referred for epigastric pain and if; Shuman performed an ultrasound examination of the gallbladder, what would Kay need to consider to properly Code this encounter? CODING TIPS AND HINTS ● Always have the latest edition of CPT and HCPCS. . Follow the “CCI” information quarterly. . Never code something because it is "close" to the description; research it further. ● Review the guidelines and refer to them as part of your routine. It would be extremely difficult for anyone person to know all the specific guidelines. ● Keep the lines of communication open with the physician and never hesitate to ask for clarification. ● Develop am! use an audit sheet that you are comfortable with and do periodic code reviews. This may not be your responsibility, but understanding how a chart auditis done can help you in your coding responsibilities. ● Know the modifiers and use them when appropriate. ● Know abbreviations, especially for laboratory procedures. Legal and Ethical Issues Medical assistants must be responsible and remain knowl¬edgeable about CPT to ensure that no fraud takes place in the coding and claims submission process. Medical assis¬tants should also ensure that proper precautions are taken to avoid incorrect coding, data entry errors, and false claims submissions. Codes or narratives should not be altered in patient chart documentation to increase insurance reimburse¬ment or to accommodate policy coverage requirements. Deliberate misrepresentation may carry criminal and/or civil penalties.

Understanding Evaluation and Management

Factors Considered in E&M CodingType of Service: Services covered in the E&M section include, but are not limited to, physician encounters in all locations for "well" or "sick" visits, patient transpo…

CPT Procedural Coding Basics

<div>Current Procedural Terminology (CPT) codes is a Medical Billing Coding set maintained by the editorial panel of the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page" target="_blank" rel="nofollow">American Medical Association</a> (AMA). The CPT Procedural Coding set is used for standard documentation of medical, surgical and diagnostic services among physicians, patients, coders, accreditation organizations, insurance payers and medical data analysts. 
<div class="separator" style="clear: both; text-align: center;"><a href="http://www.medicalbillingcodings.org/2011/03/basics-of-procedural-coding_12.html" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="CPT Procedural Coding Basics" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTQQldWOIOcuTlO5TOGMIOqbKbXpgeJ0F5E9INYoFSgroJOwp-4_y07y1YomuN_Vdcsml9iLuiXaAkYwd-8-CHvlU_m8bCHUK48HEw8CTR8yyW9rnYrg4cxqejtYtqttT8nOfboYCdez5s/s250/2013_CPT_Coding_Book.jpg" /></a></div>CPT Procedural Coding is used by Medicare, Medicaid and most commercial insurance companies to identify and classify claims for payment. Although its use is standard in physicians' practices, CPT is not recognized in some facility settings or under special guidelines within an insurance company. Physicians and Healthcare Practices use CPT Coding to: 
<ul><li>Submit claims for services and procedures</li>
<li>Track utilization of services and procedures</li>
<li>Measure physician productivity</li> 
</ul>Medical Biller, Medical Coder or Medical Billing Specialist are expected to adhere to ethical standards when involved in all aspects of coding. Again, as with diagnostic coding, the Medical Coder should consult the attending healthcare provider for clarification when a question arises. Medical Coder, because of their involvement in both clinical and administrative aspects of the health care setting, are key persons in converting the verbal and written reasons for an encounter into the universally accepted numeric and alphanumeric codes of CPT. 
 
As with <a href="http://www.medicalbillingcodings.org/search/label/ICD%20code">ICD Diagnostic Coding</a>, accurate use of the CPT codes is essential for a Medical Biller. Medical Billing Specialist facilitates the accurate medical record keeping and the efficient processing of claims reimbursement by using the CPT Codes, which identifies appropriate procedures and services performed by the physician office. CPT-4 Codes are used in the claims submission process to receive reimbursement from payers as well as to track physician productivity. CPT4 codes must be maintained, following the changes in guidelines and regulations. 
 
<h3>Evolution of CPT Coding</h3>Current Procedural Terminology was first published in 1966 by the American Medical Association. It was based on the California Relative Value Study, developed by the California Medical Society. Its primary purpose was to simplify the reporting of procedures and/or services provided by physicians. 
 
In 1992 the most significant change was made to CPT Coding with the replacement of the office and hospital visit codes with the Evaluation and Management (E&M) codes, identifying key elements to be documented in the medical record. CPT has been revised three times; the edition in current use is CPT-4. 
 
<h3>Updates to the CPT</h3>CPT is updated every October by the AMA and published for the next calendar year. The CPT Codes are available as a printed manual or as an electronic file. As with the ICD-9CM, it is ideal to purchase the printed version to be certain you have the entire contents for CPT Codes Reference. 
 
Because, medical practice is constantly changing and new procedures are being developed, the AMA encourages suggestions from physicians, medical societies, and organizations. <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/applying-cpt-codes/request-form-categories-i-iii.page" target="_blank" rel="nofollow">Forms</a> are available from the AMA CPT Editorial Research and Development Department and on the AMA website. These changes are found in Appendix B of the CPT manual. 
 
<h2>Format of the CPT Codes</h2>There are three levels of CPT: 
 
Level I CPT Codes codes are developed by the AMA and contained in the current CPT Manual. They are 
five-digit codes and two-digit modifiers. 
 
Level II CPT Codes codes, known as HCPCS, are national codes developed by CMS to describe medical services and supplies not covered in the CPT. They consist of alphabetic characters (A through V) and four digits. Modifiers are either alphanumerical or two letters (AA to VP). 
 
Level III CPT Codes codes are local codes. Unlike Level I and II, these codes are not common to all carriers. They are assigned by local Medicare carriers to describe new procedures that are not yet in Levels I and II. These codes start with a letter (W through Z) followed by four digits. 
<blockquote style="color:red">Note: when the HIPAA Standards for Electronic Transactions are fully implemented, Level III CPT Codes will no longer be recognized for reimbursement reporting.</blockquote>Following are the sections of CPT Codes: 
 
<h3>Evaluation and Management (E&M)</h3>The E&M section appears in the front of the CPT Manual and must be thoroughly understood. There is the most room for error when coding in this section. Since all specialties bill these services and these codes constitute 65% of the total Medicare part B payments to physicians, it is extremely important to understand this section. A full section devoted to understanding E&M coding appears later in this chapter. 
 
<h3>Anesthesia Codes</h3>This section contains anesthesia and modifier codes plus the very specific physical status modifiers developed by the American Society of Anesthesiologists to rank patients by level of complexity. The modifiers range from PI (normal healthy) through P6 (brain dead) patients whose organs are being removed for transplantation. There are also add-on codes (+) that explain difficult circumstances. These are located in the Anesthesia Guidelines found at the beginning of the section and also in the medicine section of the CPTA. 
 
<h3>Surgery</h3>The surgery section is further divided into 18 subsections by specific type of surgery. General guidelines are found at the beginning of the section and apply to all subsections. The subsections have specific guidelines that apply to that particular area. The subsections are further divided into subheadings. One of the most important explanations in the general guidelines is the definition of the surgical package; it is essential to know exactly what is and is not included in the package. All surgeries have global periods. These range from 0 (the actual calendar day of the procedure) up to 90 days (starting the day before the surgery and continues for 90 days). These global periods cover normal "routine" care during that time. Complications, new problems, or other injuries are reported using modifiers. 
 
<h3>Radiology</h3>In addition to radiology (x-ray diagnostic procedures), this section includes nuclear medicine and diagnostic ultrasound. This section requires a written report from the radiologist to the physician that ordered the test. 
 
<h3>Pathology and Laboratory CPT Codes</h3>Pathology and Laboratory codes in the pathology and laboratory section cover laboratory tests and services of pathologists. It is important to understand that some tests are grouped into panels. These panels give a clearer picture of problems with an organ or disease. 
 
<h3>Medicine CPT Codes</h3>The medicine section covers a multitude of services provided to patients ranging from immunization through testing that is not included in other sections to services provided by a psychiatrist or a physical therapist, and osteopathic manipulation to home healthcare. 
 
<h2>CPT Procedure Codes Look up</h2>Attempting to code services without a working knowledge of the guidelines can lead to improper coding and possibly loss of revenue. Thus, a Medical Coder needs to carefully read and understand these guidelines. Each section is unique and has very specific requirements. 
 
Guidelines at the beginning of each section of the CPT manual refer to the whole section. Guidelines specific to the subsections are listed as Notes at the beginning of the subsection. Below is the explanation of CPT classifications of Sections for an easy CPT Procedure Codes Look up: 
 
Section is highest level grouping of codes e.g Surgery, Laboratory, Radiology. 
SubSection better defines the Section. 
SuHeading further defines the SubSection. 
Category directs you to the specific CPT Procedures in which you will find the right code to use. 
 
<h3>Steps in CPT Coding</h3>The following is a brief outline of the considerations a Medical Coder is required to use in CPT coding: 
<ol><li>Know the CPT code book; there are changes each year, so even if you have been coding for years, you need to read the introduction, guidelines, and notes. 
 
</li><li>Review all services and procedures performed on the day of the encounter. Include all medications administered and trays and equipment used. 
 
</li><li>Find the procedures and/or services in the index in the back of the CPT book. This will direct you to a code (not a page number!). The code you are looking for may be listed as a procedure, body system, service, or abbreviation (this will usually refer you to the full spelling). 
 
</li><li>Read the description in the code and also any related descriptions that follow a semicolon; this will lead you to the most accurate code. 
 
</li><li>If the service is an E&M Code, identify and perform the following: <ul><li>Whether this is a new or established patient.</li> 
<li>Whether this is a consultation.</li> 
<li>Where the service was performed.</li> 
<li>Review the documentation to determine the level of service.</li> 
<li>Check to determine whether there is a reason to use a modifier.</li> 
<li>Assign the five-digit CPT code.</li></ol></li></ul> 
<h3>Medical Billing and Coding Vocabulary</h3>Bundled Codes - Procedures or services that are grouped together and paid as one. 
Unbundled codes - Separating the components of a procedure and reporting them separately. 
Component - A constituent part; a part of a larger group. 
Upcoding - A deliberate increase in a CPT code to receive higher reimbursements. 
Downcoding - A change in code done by the insurance company that receives a claim resulting in a lesser reimbursement. The change will usually be the code closest to the one submitted on the claim, because the code does not match in some way to the specifications of the insurance company. 
Modifiers - Code additions that explain circumstances that alter a service that has been provided and clarify exactly what was done to the patient. 
Morbidity - The relative incidence of disease. 
Mortality - The number of deaths in a given time or place. 
Revenue - The total income produced by a given source. 
Utilization - Related to the process of reviewing procedures and services for medical necessity. 
 
<h2>CPT Coding Assignment for Medical Billers</h2>By the time you reach here, reading this article, we expect you have established a good basic understanding on CPT coding. Below is an assignment for Medical Billing beginners to further their knowledge: 
<ul><li>Define and Spell the Terms listed in the Vocabulary above.</li>
<li>Identify Three purposes of the CPT.</li>
<li>List the Classifications of Sections in the CPT.</li>
<li>Explain the use of Guidelines and where they are located.</li>
<li>Discuss the Importance of Modifiers.</li>
<li>Briefly explain the importance of correctly assigning E&M codes.</li> 
<li>Define up-coding and explain why it must be avoided.</li>
<li>Accurately assign a CPT code based on medical documentation.</li> 
</ul> 
 
</div>

CPT Procedural Coding Basics

Current Procedural Terminology (CPT) codes is a Medical Billing Coding set maintained by the editorial panel of the American Medical Association (AMA). The CPT Procedural Coding set is used for standa…

Influenza, Pneumococcal Billing & Reimbursement

When the same type of vaccine is administered to fewer than 5 Medicare beneficiaries on the same day, you must submit the claim(s) individually via the 'Home Health' Option 26 from the Claims Entry Menu. 
 
The influenza virus vaccine and pneumococcal pneumonia vaccination (PPV) are billed on a 341 type of bill (home health outpatient Part B benefit). 
 
The beneficiary must be eligible for Medicare Part B to receive reimbursement for these services. 
<ul><li>Children, ages 6-35 months 
90655 - Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use</li>
<li>Children, ages 0 months through age 18.99 
90660 – Influenza virus vaccine, live, for intranasal use 
90670* - Pneumococcal conjugate, 13 valent, for intramuscular use 
*Replaces 90669 7/1/2010</li>
<li>Children, ages 2+ 
90656 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use 
90658 - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use 
90732 - Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use</li>
<li>Children, under age 9 
Reimbursement for administration of both doses of seasonal influenza are eligible in the following situations as indicated by HEALTH: 
 
<div style="text-align: center;"><a href="http://www.medicalbillingcodings.org/2011/03/2010-2011-influenzapneumococcal-billing_12.html" imageanchor="1" style="clear:right; float:right; margin-left:1em; margin-bottom:1em"><img alt="2010-2011 Influenza/Pneumococcal Billing & Reimbursement" border="0" height="227" src="http://1.bp.blogspot.com/-fV1i5HgM23o/Tzkr1A0nBfI/AAAAAAAAADA/IRGzoQ-O4kI/s320/medicalCareer.jpg" width="320" /></a></div> 
If they did not receive H1N1 flu vaccine last year* 
First time ever receiving flu vaccine* 
Received seasonal flu last year, but only one dose was administered</li>
<li>Adults 19-65* 
90656 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use 
90658 - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use 
90660 – Influenza virus vaccine, live, for intranasal use (members aged 19-49 only) 
90732 - Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use 
*Members who are enrolled on Extended Family Planning (EFP) benefits are not eligible.</li>
<li>Vaccine Administration Coding (under 8 years) 90465 – Initial IM 
90466 - Subsequent IM (add-on code) 
90467 – Initial oral/nasal 
90468 – Subsequent oral/nasal (add-on code) 
90465 & 90467 will bundle when billed together on the same day and deny.</li>
<li>Vaccine Administration Coding (all ages) 
90471 - Initial IM 
90472 – Subsequent IM (add-on code) 
90473 – Initial oral/nasal 
90474 – Subsequent oral nasal (add-on code) 
90471 & 90473 will bundle and deny if billed together on the same day</li>
</ul>

Influenza, Pneumococcal Billing & Reimbursement

Medical Billing and Coding: Statement of Coding Ethics

In this era of payment based on diagnostic and procedural coding, the professional ethics of health information coding professionals continue to be challenged. A conscientious goal for coding and maintaining a quality database is accurate clinical and statistical data. The following standards of ethical coding, developed by AHIMA's Coding Policy and Strategy Committee and approved by AHIMA's Board of Directors, are offered to guide coding professionals in this process. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR2NlRZa4J4byLhppyCyoLPkN781GMJgf5vZ2ARFTaQ5zBGKV5Pm8epqsuyDU2XH1qjV5SY_V7MNCIYM-udHielOJWKWxw5uYF0icNLnmQO-D-fB176pdsoezAQbSIEmCpvhcjzNeAeT8/s1600/ethics.jpg" imageanchor="1" style="clear:right; float:right; margin-left:1em; margin-bottom:1em"><img border="0" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR2NlRZa4J4byLhppyCyoLPkN781GMJgf5vZ2ARFTaQ5zBGKV5Pm8epqsuyDU2XH1qjV5SY_V7MNCIYM-udHielOJWKWxw5uYF0icNLnmQO-D-fB176pdsoezAQbSIEmCpvhcjzNeAeT8/s200/ethics.jpg" width="200" /></a></div> 
 
 
 
1. Coding professionals are expected to support the importance of accurate, complete, and consistent coding practices for the production of quality healthcare data. 
 
2. Coding professionals in all healthcare settings should adhere to the ICD-9-CM (International Classification of Diseases, 9th revision, Clinical Modification) coding conventions, official coding guidelines approved by the Cooperating Parties,* the CPT (Current Procedural Terminology) rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets. Selection and sequencing of diagnoses and procedures must meet the definitions of required data sets for applicable healthcare settings. 
 
3. Coding professionals should use their skills, their knowledge of currently mandated coding and classification systems, and official resources to select the appropriate diagnostic and procedural codes. 
 
4. Coding professionals should only assign and report codes that are clearly and consistently supported by physician documentation in the health record. 
 
5. Coding professionals should consult physicians for clarification and additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record. 
 
6. Coding professionals should not change codes or the narratives of codes on the billing abstract so that meanings are misrepresented. Diagnoses or procedures should not be inappropriately included or excluded because payment or insurance policy coverage requirements will be affected. When individual payer policies conflict with official coding rules and guidelines, these policies should be obtained in writing whenever possible. Reasonable efforts should be made to educate the payer on proper coding practices in order to influence a change in the payer's policy. 
 
7. Coding professionals, as members of the healthcare team, should assist and educate physicians and other clinicians by advocating proper documentation practices, further specificity, and re-sequencing or inclusion of diagnoses or procedures when needed to more accurately reflect the acuity, severity, and the occurrence of events. 
 
8. Coding professionals should participate in the development of institutional coding policies and should ensure that coding policies complement, not conflict with, official coding rules and guidelines. 
 
9. Coding professionals should maintain and continually enhance their coding skills, as they have a professional responsibility to stay abreast of changes in codes, coding guidelines, and regulations. 
 
10. Coding professionals should strive for optimal payment to which the facility is legally entitled, remembering that it is unethical and illegal to maximize payment by means that contradict regulatory guidelines. 
 
Revised 12/99 The Cooperating Parties are the American Health Information Management Association, American Hospital Association, Health Care Financing Administration, and National Center for Health Statistics. All rights reserved. Reprint and quote only with proper reference to AHIMA's authorship.

Medical Billing and Coding: Statement of Coding Ethics

Medical Billing and Coding Profession

<div align="justify">Delivering quality healthcare depends on capturing accurate and timely medical data. Medical coding professionals fulfill this need as key players in the healthcare workplace. 
 
The medical coding professional (or coder) is responsible for translating healthcare providers’ diagnostic and procedural phrases into coded form. Coding professionals do this by reviewing and analyzing health records to identify relevant diagnoses and procedures for distinct patient encounters. This translation process requires interaction with the healthcare provider to ensure terms are translated correctly. 
 
Coding professionals must possess a thorough understanding of the health record’s content in order to find information to support or provide specificity for coding. Certified medical coders are trained in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded. The job entails much more than simply locating diagnostic and procedural phrases in the coding manuals or with encoder software. It requires knowledge of disease processes and procedural techniques to consistently apply the correct codes. A medical coding professional works as part of a team to achieve the best quality patient care. 
 
AHIMA supports multiple certifications, providing both personal validation and confirmation of professional competence for employers and consumers. Learn more about AHIMA certifications. 
 
Medical coding professionals work in a variety of healthcare settings, including inpatient and outpatient healthcare settings and non-provider settings such as third-party payers and healthcare software vendors. 
 
Typical medical coding professional job descriptions include: 
 
•Hospital outpatient coder 
•Hospital inpatient coder 
•Hospital coding manager 
•Professional fee coder 
 
Related jobs, employing similar record analysis and coding skills, include: 
 
•Clinical data specialist 
•Data quality manager 
•HIM compliance specialist 
 
Nationwide, there is a shortage of certified medical coders in hospitals, physician practices, and other healthcare facilities. According to the United States Bureau of Labor, employment of medical record and health information technicians is expected to grow much faster than the average field. 
 
Each year, AHIMA collects professional data from its credentialed members as part of the annual membership cycle. Review the AHIMA 2008 Salary Study to find out additional information on trends in the health information management (HIM) industry, including medical coder salaries. 
 
As you begin your job search, visit Career Assist for guidance and to connect with new employment opportunities. 
 
Career Self-assessments are created to assist a professional in managing his or her professional pathway. The following assessments focus on careers related to medical coding. 
 
•Coding Manager 
•Inpatient Coder </div>

Medical Billing and Coding Profession

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Medical Billing and Coding: Statement of Coding Ethics

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