CPC Practice Exam

Medical Coding Books

The term "medical coding books" generally describes the three coding books that medical coders use; the CPT, ICD-9-CM, and HCPCS.

These coding books are used to translate a written medical record into number sets prior to insurance submission.

Number sets, also called medical codes, each represent a unique descriptor found in one of the three books.


CPT, ICD-9-CM, & HCPCS

Three Medical Coding Books:

Codes can be selected from one, two, or all three medical coding books when coding a single medical record. Each book is distinct from the other, carrying it's own set of unique codes, descriptors, and guidelines.

Current Procedural Terminology (CPT)

The CPT book was founded by the American Medical Association (AMA) in 1966 and is updated annually with changes effective January 1st of each year.

The Current Procedural Terminology book contains medical codes that are often called CPT codes or National Level I codes.

These CPT codes depict procedures and services that can be performed by physicians, surgeons, specialists, and ancillary staff.

In professional coding CPT codes are what insurance companies base their reimbursement on.

All CPT medical codes are completely numeric and they are always five digits in length. Each five digit number set is unique and is not repeated in any other medical coding book. Each medical code also has a unique detailed descriptor attached to it.


CPT Examples

26740 - Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each

76813 - Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation

13121 - Repair, complex, scalp, arms, and/or legs; 2.6cm - 7.5cm

  • CPT Codes Include:
~Evaluation and Management, Anesthesia, Radiology, Pathology, and Medicine codes.

~ Codes for surgical procedures performed on the following organ systems: Integumentary, Musculoskeletal, Respiratory, Cardiovascular, Hemic and Lymphatic, Mediastinum, Digestive, Urinary, Male and Female Genitalia (includes maternity procedures), Nervous, Ocular, and Auditory.

  • CPT Book Layout:
~ CPT guidelines, medical terminology, and anatomy charts are located in the front of the CPT book.

~ E/M codes are listed next, followed by Anesthesia, Surgery (by organ system), Pathology, Radiology, and Medicine codes.

~ Category II and III codes are listed next. These unique codes are use for quality control measures and new technology.

~ Appendicies A - M are located near the end.

~ The alphabetic Index makes up the final portion of the CPT book and is used to look up codes by procedure name or anatomical locaiton.


International Classification of Diseases, 9th Edition, Classification Modification (ICD-9-CM)

This medical coding book was first published in 1948 and is updated every year with changes effective October 1st of each year.

The ICD-9-CM (also known as the ICD-9) is divided into three volumes. Volume I is known as the Tabular Index, Volume II is known as the Alphabetic Index, and Volume III is known as either the Operative Index or the Procedure Index.

medical coding books Volumes I and II are used in both the professional and facility settings and Volume III is reserved for facility settings only.

Volumes I and II contain medical codes that depict a diagnosis. These "diagnosis" codes are used to describe accidents, illnesses, injuries, and conditions.

Codes from this medical coding book are three to five digits in length, have a decimal point following any third digit, and can be numeric or alpha-numeric in nature.

Volume III contains medical codes for procedures performed in a facility setting. These medical codes are numeric, three to four digits in length, and have a decimal point following any second digit. Volume III also has a separate alphabetic index for locating its codes.


ICD-9-CM Examples

Volume I & II

881.00 - Open wound of elbow, forearm,
and wrist, without mention of complication, forearm

448.1 - Influenza due to identified novel H1N1 influenza virus (2009 Swine)

643.03 - Excessive vomiting in pregnancy, mild hyperemesis gravidarum, antepartum condition or complication.

V03.7 - Need for prophylactic vaccination and inoculation against bacterial diseases; Tetanus toxoid alone

Volume III

57.94 - Insertion of indwelling urinary catheter.

06.12 - Open biopsy of thyroid gland.

  • ICD-9-CM Codes Include:
~ 3-5 digit numeric codes that describe accidents, illnesses, injuries, diseases, and conditions.(vol.I&II)

~ 3-4 digit numeric codes that describe in patient procedures (vol. III)

~ V codes; 3-5 digit codes that begin with a V and decribe circumstances for healthcare encounters.

~ "E" Codes; 3-5 digit codes that begin with an E and describe how an accident or injury occured.

  • ICD-9-CM Book Layout:
~ Guidelines, conventions descriptions, & Code change summaries are located at the begining of the book.

~ Volume II (Alphabetic Index) is located next. This lists all accidents, injuries, diseases, and conditions alphabetical by name and includes three tables; Table of Hypertension, Table of Neoplasms, & Table of Chemicals and Drugs.

~ External cause index (E code index) is used specifically to reference E codes. This index is located between Volumes I and II.

~ Volume I (Tabular Index) makes up the center portion of the book. This contains all codes with their full descriptions, conventions, and notaitons.

~ Appendicies A-E

~ Alphabetic index for Volume III. This lists all in patient procedures in Volume III alphabetically for reference.

~ Tabular index for Volume III. This index contains all Volume III codes with their full descriptions, conventions, and notations.

~ References

Healthcare Common Procedural Coding System (HCPCS)

The final medical coding book is the Healthcare Common Procedural Coding System (HCPCS, pronounced "hicks-picks"). The HCPCS book was developed by Medicare in 1983 and is updated annually with changes effective January 1st of each year.

HCPCS codes are also know as National Level II codes. These codes are used to depict non-physician services, Durable Medical Equipment (DME), supplies, and drugs that are not covered by CPT national level I codes.

HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book.


HCPCS Code Examples

K0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking

A5120 - Skin barrier, wipes or swabs, each

Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster.

  • HCPCS Codes Include:
~Medicaland surgical supplies, durrable medical equipment, drugs, and other medical services not listed in the CPT coding book.

  • HCPCS Layout:
~ Alphabetic index which lists all codes alphabetically by name is listed in the front of the book.

~ The Table of Drugs with drugs listed alphabeticaly is next.

~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index.

~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book.

~ Appendix A which is for Internet Only Manuals makes up the remainder of the book.


medicalcodingbook

Book Notations

Some certification exams allow high lighting and hand written notes in your medical coding books.

Making tabs on the side of your books for easy referencing is also helpful.

Also, consider using a pencil eraser or rubber thumb to aid in quick page turning.

Exam Tips

Certification exams do not require memorization, just an extensive knowledge of your medical coding books.

The answer to almost every question is located in one of the medical coding books, you just need to know how to find it.

Tips:

  • Common medical terms are located on pages xiv and xv of the CPT book
  • Anatomical illistrations are located in the CPT on pages xix and at the begining of each surgery chapter
  • Modifiers can be referenced on the front cover of the CPT book
  • Common abbreviations are located on the back cover of the CPT book
  • Each of the medical coding books have general guidelines listed in the front, read and highlight these
  • Conventions are explained in code book guidelines and quick referenced at the bottom of tabular pages

Coding Book
Reqirements

Be sure to check out what medical coding books are approved and which ones are not prior to sitting for your certification exam.

Only the Standard or professional edition CPT book printed by the AMA is approved for the CPC exam, and although the expert edition of the ICD-9-CM once was not excepted it is now approved.

For a full list of approved manuals checked the AAPC and AHIMA websites.



ICD-10

Out of the three medical coding books the ICD-9-CM is the oldest.

Decades of updates and revisions has created a decrease in code detail as well as a lack of room to expand with technology.

The solution? The ICD-10-CM and ICD-10-PCS.

The ICD-10-CM will replace Volumes I and II in the ICD-9 and the ICD-10-PCS will replace Volume III.

With well over 100,000 additional codes these books will be in effect October 1, 2013......(more)


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