• Why is it important to understand the different diagnostic codes within medical records? Provide details and examples.  
•  What is the difference between a complication and comorbidities?
• Provide examples as to how ICD-9 and ICD-10 differ. In what ways are they similar?

 

Medical billing requires skilled professionals who can read, interpret, record, and track complex medical information quickly, maintain patient confidentiality and strong attention detail. Medical coding takes information about diagnoses, treatments, procedures, medications and equipment and translates them in to alphanumeric codes. This information comes from a range of sources, including transcriptions, medical notes, electronic records, lab results including blood work, urinalysis and pathology and radiologic assessments Understanding these diagnosis codes enables medical coding professionals to transfer these codes from the sources to medical billing systems and patient records. This is an important step required to submit medical claims with insurers. Coding is critical as it can directly affect medical care, particularly as it related to insurance reimbursements. In today's fee-for-service medical requirement, physicians are increasingly required to list underlying conditions, untreated diagnoses, and preconditions. Its important to have proper medical coding since it ensures that insurers have a diagnostic codes required for appropriate payment. Coding is also important for demographic assessments and studies of disease prevalence, treatment outcomes and accountability based reimbursement systems.

A diagnostic code is a combination of letters and/or numbers assigned to a particular diagnosis, symptom, or procedure. For example, James comes to doctor's office complaining of pain when urinating. the health care provider performs a urinalysis and discover several abnormal findings that indicate infection. the provider concludes that she has a urinary tract infection. On the check-out slip, the healthcare provider will reference several codes like;

1. N39.0- which stands for a urinary tract infection, and
2. R82.90- which stands for unspecified abnormal findings in urine.

For the purpose of coding diagnoses on claims, a complication is a condition that arises during the hospital stay that prolongs the length of the stay while a comorbidity is a pre-existing condition that affects the treatment received and/or prolongs the length of the stay. Comorbidity describes the effect of all other conditions an individual patient might have other than the primary condition of interest and can be physiological or psychological. A complication is so called because it complicates existing condition.

ICD-9 and ICD 10 codes differ in various ways. They include;

1. ICD-10 codes may contain more digits than the traditional ICD-9 codes used. ICD-9 codes can contain between three and five digits, but ICD-10 codes can be anywhere from three to seven digits long.
2. ICD-10 codes begin with a letter while the first digit of ICD-9 code can either be alpha or numeric.
3. In ICD-9, digits three through five were always numeric whereas in ICD-10, third and subsequent digits are either alpha or numeric.
4. ICD -10 provides a great deal of flexibility for creating new codes since it was the main and biggest reason for the change from ICD-9 to ICD-10, to make it easy add recently discovered diseases.
5. ICD-10 codes are more specific as compared to ICD-9 codes since they are designed to eliminate coding errors that could result in denied claims.

However, ICD-9 and ICD-10 are similar in some ways. This include;

1. In both a hierarchical structure is used, getting more specific with more digits.
2. The conventions are similar; brackets are used in alphabetical index to represent manifestations, and "NOS" is used to denote -not otherwise specified.
3. In both, the mechanisms of looking up a diagnosis in the alphabetical index and then verifying in tabular list is required.