MEDICAL BILLING AND CODING CERTIFICATION

1 MEDICAL BILLING AND CODING CERTIFICATIONDOWNLOADABLE EBOOK2 | TABLE OF CONTENTSTABLE OF CONTENTSI ntroductionWhat is MEDICAL BILLING and CODING ?Working in MEDICAL BILLING and CodingMedical CODING CertificationMedical BILLING CertificationLearn More About MEDICAL CodingMedical CODING Vocabulary & Key TermsICD-9 & ICD-9-CMUsing ICD-9-CMICD -10 -CMUsi ng ICD -10 -CMIntro to CPTU sing CPTCPT ModifiersHuman Anatomy and MEDICAL TerminologyHCPCS CodesHCPCS ModifiersCrosswalkingElectronic vs. Paper CodingMedical CODING ReviewIntroduction to MEDICAL BillingMedical BILLING VocabularyThe MEDICAL BILLING ProcessMore About Insurance and the Insurance Claims ProcessMedicare & MedicaidMedicare.

2 Medicaid and MEDICAL BillingPotential BILLING Problems and Returned ClaimsH I PA A 101 HIPAA and MEDICAL BillingMedical BILLING Review Try MEDICAL CodingTry MEDICAL BillingCommon Problems in MEDICAL CodingSECTION 1 SECTION 2 SECTION 3 SECTION 4568121416222634384448546068788286909298 102108112116120122126130132 136142146 TABLE OF CONTENTS | 3 TABLE OF CONTENTSWhat is the CPC Exam?General Preparation and Test Strategies for the CPC ExamCPC Exam: AnesthesiaCPC Exam: RadiologyCPC Exam: MedicineCPC Exam: The Nervous SystemCPC Exam: the Endocrine SystemCPC Exam: Digestive SystemCPC Exam: The Urinary SystemCPC Exam: The Musculoskeletal SystemCPC Exam: Evaluation and ManagementCPC Exam: Anatomy and PhysiologyCPC Exam: Mediastinum and DiaphragmCPC Exam: Practice ManagementCPC Exam: Male and Female Genital SystemCPC Exam: Hemic and Lymphatic SystemCPC Exam: Maternity and DeliveryCPC Exam: Eye and Ocular AdnexaCPC Exam: ICD-9-CMCPC Exam.

3 HCPCS Level IICPC Exam: CODING GuidelinesCPC Exam: MEDICAL TerminologyCPC Exam: Pathology and LaboratoryCPC Exam: Integumentary CPC Exam: Respiratory SystemCPC Exam: Cardiovascular SystemCPC Exam: Where to Take an ExamThe CPC Apprentice ProgramThe CPB ExamAccredited BILLING and CODING SchoolsHow to Recognize Industry ScamsGetting Your First MEDICAL BILLING and CODING JobSECTION 5 SECTION 6148152156160162166168172174176178182186 1881901921941961982002022042082102122142 162182202222262284 | INTRODUCTIONINTRODUCTION | 5 INTRODUCTIONThis ebook will brief you on every aspect of the MEDICAL BILLING and CODING field: from a breakdown of each code set to starting your own practice.

4 Along with our online video courses, we provide free downloadable resources like Powerpoint presentations, vocabulary lists, sample problems, and review quizzes to help you in your course is divided into six sections. In section one, we introduce you to the general topic of MEDICAL BILLING and CODING . In section two, we talk about the practice and the basics of the MEDICAL CODING process. In section three, you learn about the MEDICAL BILLING claims process and how it pertains to health insurance payers, Medicare and Medicaid, and the rest of the healthcare industry.

5 In section four, we apply the knowledge you ve learned and work with some real-world problems in CODING and BILLING . This section gives you a detailed look into what it s like to work as a MEDICAL coder or section five, we help you prepare for the American Association of Profession-al Coder s Certified Professional Coder exam. And finally, in section six we show you some of the next steps to take in the field, including where to go to school, where to get certified, and how to avoid online scams. Bear in mind that this ebook, and all our provided content on our website alone will not prepare you to take the exams to become a certified MEDICAL biller or coder.

6 In order to learn the specifics of these fields and prepare yourself for their exams, you ll want to take classes at one of the many schools and training programs around the country. You can count on us for that, too: our website can help you pick out the school or training program that s right for you. Let s get started!DOWNLOADABLE MATERIALDISCLAIMER6 | SECTION 1 WHAT IS MEDICAL BILLING AND CODING ? MEDICAL CODINGMEDICAL CODING EXAMPLEM edical BILLING and CODING are two closely related aspects of the modern health care industry. Both practices are involved in the immensely important reimbursement cycle, which ensures that health care providers are paid for the services they CODING , at it s most basic, is a little like translation.

7 It s the coder s job to take something that s written one way (a doctor s diagnosis, for example, or a prescription for a certain medication) and translate it as accurately as possible into a numeric or alphanumeric code. For every injury, diagnosis, and MEDICAL procedure, there is a corresponding code. There are thousands and thousands of codes for MEDICAL procedures, out- patient procedures, and diagnoses. We ll cover which codes represent which injury or sickness, and which codes correspond to each procedure, in greater depth in Section 2. For now, let s start with a quick example of MEDICAL CODING in patient walks into a doctor s office with a hacking cough, high production of mucus or sputum, and a fever.

8 A nurse asks the patient their symptoms and performs some initial tests, and then the doctor examines the patient and diagnoses bronchitis. The doctor then prescribes medication to the patient. Every part of this visit it recorded by the doctor or someone in the healthcare provider s office. It s the MEDICAL coder s job to translate every bit of relevant information in that patient s visit into numeric and alphanumeric codes, which can then be used in the BILLING process. There are a number of sets and subsets of code that a MEDICAL coder must be familiar with, but for this example we ll focus on two: the International Classification of Diseases, or ICD, codes, which correspond to a patient s injury or sickness, and Current Procedure Terminology, or CPT, codes, which relate to what functions and services the healthcare provider performed on or for the patient.

9 These codes act as the universal language between doctors, hospi-tals, insurance companies, insurance clearinghouses, government agencies, and other health-specific organizations. The coder reads the healthcare provider s report of the patient s visit and then translates each bit of information into a code. There s a specific code for what kind of visit this is, the symptoms that patient is showing, what tests the doctor does, and what the doctor diagnoses the patient with. Every code set has its own set of guidelines and rules. Certain codes, like ones that signify a pre-existing condition, need to be placed in a very particular order.

10 CODING accurately and within the specific guidelines for each code will affect the status of a claim. WHAT IS MEDICAL BILLING AND CODING ? | 7 The codes for the procedures performed must also correspond to the diagnoses made by the physician. Having the correct procedure codes match up with the diagnosis codes ensures that healthcare providers and patients will be properly reimbursed by insurance companies. The CODING process ends when the MEDICAL coder enters the appropriate codes into a form or software program. Once the report is coded, it s passed on to the MEDICAL biller.