Coding and Claims Process

Primary Discussion Response is due by Wednesday (11:59:59pm Central), Peer Responses are due by Sunday (11:59:59pm Central).

Primary Task Response: Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

Step 1: While assisting the coding manager in preparing for the electronic health record (EHR) implementation, you are reviewing diagnosis and procedure codes entered by the coders into the EHR.

• To understand the importance of the codes, discuss medical necessity and how the International Classification of Disease 9th Clinical Modification (ICD-9-CM) and current procedural terminology (CPT) codes help to determine medical necessity.

Step 2: While discussing coding format for the EHR with the coding manager, you learn that The International Classification of Disease 10th Clinical Modification Procedure Classification System (ICD-10-CM-PCS) will be effective soon.

Discuss the following:

• Explain when it is effective and why it replaces ICD-9-CM codes.
• Is there a difference in format for these 2 coding systems?

Be sure to support your information by citing at least 2 references using APA format.