ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization. It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury of diseases. The code set allows more than 14,000 different codes and permits the tracking of many new diagnoses. The U.S. has used ICD-10-CM (Clinical Modification) since October, 2015. This national variant of ICD-10 was provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics, and the use of ICD-10-CM codes are now mandated for all inpatient medical reporting requirements. This book is for physicians, practice managers and all others who need learn ICD-10. It’s designed for the clinician to learn how to put their diagnosis into a code and not rely on staff or computer software programs to decide it form them. ICD-10 is a complex system of coding and Medicare and third party insurers have been lenient giving providers a year to get used to the coding system. As a result, physicians and their staff have become very complacent regarding proper coding. However, Medicare and third party insurers will soon begin to deny claims which are not coded correctly, which in turn will cost physician groups time and money. This book focuses on Worker’s Compensation and Personal Injury, a very large segment of the healthcare industry and is a new area to ICD-10. The diagnosis coding for injuries is much different than for Medicare or group insurance and unless the physicians and their staff learn how to use it properly, they risk losing income for themselves and worse, they risk losing the case for the patient.

Radiology -- Rheumatology and Related -- Urology -- ENT (Otolaryngology -- Surgery: General -- Toxicology/Internal Medicine and General Medicine -- Nephrology and Cardiology -- There Are Many Possible Combination Codes -- Other Provider Requirements for ICD-10 -- Seventh-Character Codes -- Greater Level of Detail Required -- External Cause of Morbidity Codes (Transport and Other -- Other External Causes of Morbidity Code Examples -- 6 Chapter Six -- ICD-10 Coding Guidelines for General and Family Practice (Specific Coding for Differential Diagnoses -- Head/Neck -- Sore Throat -- Headache -- Eye (Vision) Problems -- Upper Extremity -- Shoulder Pain -- Elbow Pain -- Chest -- Chest Pain -- Common Respiratory Problems -- Abdomen -- Abdominal Pain -- Irritable Bowel Syndrome (IBS -- Dialysis Status -- Spine -- Back Pain -- Subluxation -- Neck Pain -- Pelvis -- Rectal Pain and Bleeding -- Urinary Tract Infection, Site Not Specified N39.0 -- Prostatitis -- Testicular Pain -- Lower Extremity -- Knee Pain -- Generalized -- Cardiovascular System -- Neuro/Psychiatry -- Neurology -- General Pain -- Diabetes -- Obesity -- Malnutrition -- Hyperlipidemia -- Dermatitis and Skin Related -- Oncology -- Women' s Health -- Other Conditions -- 7 Chapter Seven -- Worker's Compensation, Personal Injury, and Drug or Chemical Induced Diabetes -- Diabetes Mellitus Discussion -- Diabetes Mellitus in Pregnancy, Childbirth, and the Puerperium -- Use of Flowcharts -- Diabetes Flowcharts -- ICD-10-CM Draft Release Expert Edition: Diabetes Mellitus Section -- 8 Chapter Eight -- Worker' s Compensation and Personal Injury Billing Guide -- Code Extensions for External Cause Code -- Coding Injuries -- Coding of Traumatic Fractures -- Injury Coding Can Be a Big Challenge -- Place of Occurrence and Activity Codes -- Encounter Codes -- Using the Crosswalk

- NEW! Expanded coverage of inpatient insurance billing, including diagnosis and procedural coding provides you with the foundation and skills needed to work in the physician office, outpatient, and inpatient setting. - NEW! Expanded coverage of Ambulatory Surgical Center (ASC) billing chapter provides you with the foundation and skills needed to work in this outpatient setting. - NEW! Updated information on general compliance issues, HIPAA, Affordable Care Act and coding ensures that you have the knowledge needed to enter today's ever-changing and highly regulated healthcare environment.

Stay up on the latest in insurance billing and coding with Marilyn Fordney s Insurance Handbook for the Medical Office, 14th Edition.Trusted for more than 30 years, this market-leading handbook equips you to succeed as medical insurance specialist in any of today s outpatient settings. Coverage emphasizes the role of the medical insurance specialist in areas such as diagnostic coding, procedural coding, Medicare, HIPAA, and bill collection strategies. As with previous editions, all the plans that are most commonly encountered in clinics and physicians offices are incorporated into the text, as well as icons for different types of payers, lists of key abbreviations, and numerous practice exercises that assist you in accurately filling out claim forms. This new edition also features expanded coverage of ICD-10, electronic medical records, electronic claims submission, and the HIPAA 5010 keeping you one step ahead of the latest practices and protocols of the profession.Key terms are defined and emphasized throughout the text to reinforce understanding of new concepts and terminology.Separate chapter on HIPAA Compliance in Insurance Billing, as well as Compliance Alerts throughout the text highlights important HIPAA compliance issues to ensure readers are compliant with the latest regulations. Emphasis on the business of running a medical office and the importance of the medical insurance specialist details the importance of the medical insurance specialist in the business of the medical office.Increased focus on electronic filing/claims submission prepares readers for the industry-wide transition to electronic claims submission.Separate chapter on documentation in the medical office covers the principles of medical documentation and the rationales for it."Service to Patient" features in most chapters offer examples of good customer service.User resources on the Evolve companion website feature performance checklists, self-assessment quizzes, the Student Software Challenge (with cases on different payer types and an interactive CMS-1500 (02-12) form to fill in). NEW! Expanded coverage of ICD-10 prepares users to code ICD-10 with the planned effective date of October 2015.NEW! Added information on the electronic medical record and electronic claims submission including information on the HIPAA 5010 equips users for the transition between paper and electronic methods of medical records and links the CMS-1500 (02-12) form to the electronic submissions process.NEW! SimChart for the Medical Office (SCMO) application activities on the companion Evolve website adds additional functionality to the insurance module on the SCMO roadmap."

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

- NEW! Insights From The Field includes short interviews with insurance billing specialists who have experience in the field, providing a snapshot of their career paths and offering advice to the new student. - NEW! Scenario boxes help you apply concepts to real-world situations. - NEW! Quick Review sections summarize chapter content and also include review questions. - NEW! Discussion Points provide the opportunity for students and instructors to participate in interesting and open dialogues related to the chapter's content. - NEW! Expanded Health Care Facility Billing chapters are revised to provide the latest information impacting the insurance billing specialist working in a variety of healthcare facility settings.