Medical coding systems

Mushtaq Ahmad Wani

15PIM2244
M.S. (Pharm.) 3rd Semester
Department Of Pharmacoinformatics
NIPER, S.A.S. Nagar
 Medical coding systems.
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Medical coding or, medical classification is the process

of transforming descriptions of medical diagnoses and
procedures into universal medical code numbers

 The diagnoses and procedures are usually taken from a

variety of sources within the health care records, such as
the transcription of the physician's notes, laboratory
results, radiologic results
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Diagnostic codes
 Are used to determine diseases, disorders, and
symptoms
 Can be used to measure morbidity and mortality

 Examples: ICD-9-CM, ICD-10

Procedural codes
 They are numbers or alphanumeric codes used to
identify specific health interventions taken by medical
professionals.
 Examples: CPT

Pharmaceutical codes
 Are used to identify medications

 Examples: NDC
 1.ICD-9-CM
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 International Classification of Diseases, Ninth Revision, clinical
modification

 ICD codes are used to represent a doctor’s diagnosis and

patient’s condition

 Developed by W.H.O in 1948 to track diseases

 ICD codes are updated by NCHS by daily basis

 US currently coding in ICD-9-CM systems

 In the billing process, ICD is used to determine medical

necessity
 Clinical modification
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 Clinical modification is a set of revisions created by the National Center

for Health Statistics(NCHS)

 Clinical modification gives coders much more flexibility and specificity

 Ex.ICD-10 has 14,000 codes

but ICD-10-CM has 68,000+codes

 ICD-9-CM has reached its capacity of use as a coding systems

 ICD-9-CM changeover to ICD-10-CM in october of 2014

 ICD-10-CM provides more codes, more flexibility and accuracy in the

coding process
Anatomy of ICD-9 Code
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 Organization of ICD-9 Volume 1
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001-139 Infectious and Parasitic Diseases

140-239 Neoplasms
240-279 Endocrine, Nutritional and Metabolic Diseases
280-289 Diseases of the Blood and Blood-forming Organs
290-319 Mental Disorders
320-389 Diseases of the Nervous System and Sense Organs
390-459 Diseases of the Circulatory System
460-519 Diseases of the Respiratory System
520-579 Diseases of the Digestive System
580-589 Diseases of the Genitourinary System
630-676 Complications of Pregnancy, Childbirth, and the
Puerperium
680-709 Diseases of the Skin and Subcutaneous Tissue
 Organization of ICD-9 Volume 1
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710-739 Diseases of the Musculoskeletal System & Connective

Tissue
740-759 Congenital Anomalies
760-779 Certain Conditions Originating in the Perinatal Period
780-799 Symptoms, Signs and Ill-defined Conditions
800-999 Injury and Poisoning
E800-E999 Supplementary Classification of the External Causes of
Injury and Poisoning
V01-V82 Supplementary Classification of factors influencing
Health Status and Contact with Health Services
 Example
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 Turn to that ICD code in Volume 1

786.5 Chest pain

786.50 Chest pain, unspecified
786.51 Precordial pain
786.52 Painful respiration
Pain:
Pleurodynia
anterior chest wall
pleuritic

EXCLUDES
786.59 Other

Discomfort
Pressure in chest
Tightness
 2.CPT
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Current procedural Terminology

Systematic listing of procedures & services performed by

physicians

Five-digit codes for procedures or services

Used to describe the physician’s services to a patient for

diagnosis and treatment of the medical condition(s)
 Organization of CPT Manual
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 Text organized in 6 major sections

(00100 - 99499)
Evaluation and Management (99201
Anesthesiology
01999, 99100-99140)

Surgery
(10040 - 69990)

Radiology
(70010 - 79999)

Pathology and Laboratory

(80049 - 89399)
Medicine (90281 - 99199)
 Example
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Electrocardiogram (ECG or EKG) (CPT 93000)

Procedure code and description

93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and
report

93005 - Electrocardiogram, routine ECG with at least 12 leads; tracing only, without
interpretation and report

93010 - Electrocardiogram, routine ECG with at least 12 leads; interpretation and report
only

93040 - Rhythm ECG, 1-3 leads; with interpretation and report

93041 - Rhythm ECG, 1-3 leads; tracing only without interpretation and report

93042 - Rhythm ECG, 1-3 leads; interpretation and report only

 3. NDC
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 The NDC, or National Drug Code, is a unique 10-digit, 3-segment number

 It is a universal product identifier for human drugs in the United States

 The code is present on all nonprescription (OTC) and prescription

medication packages and inserts in the US

 The 3 segments of the NDC code:

I. The first set of numbers in the NDC identifies the labeler (manufacturer,
repackager, or distributer).
II. The second set of numbers is the product code, which identifies the specific
strength, dosage form (i.e, capsule, tablet, liquid)
III. the third set is the package code, which identifies package sizes and types.
 Example
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The NDC for a 100-count bottle of Prozac 20 mg is 0777-3105-02

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