HTH 1304, Health Information Technology and Systems 1

Course Learning Outcomes for Unit III Upon completion of this unit, students should be able to:

4. Differentiate various health information standards in terms of their ability to support the requirements of a health care enterprise. 4.1 Explain specific health care coding sets used in the nomenclature and classification of medical

diagnoses. 4.2 Outline government regulations regarding health care coding sets.

5. Identify health information technologies necessary for effective data storage and use in health care

organizations. 5.1 Describe the interoperability required in the transmission of diagnostic information.

Course/Unit Learning Outcomes

Learning Activity

4.1 Unit Lesson Chapter 5 Unit III PowerPoint Presentation

4.2 Unit Lesson Chapter 5 Unit III PowerPoint Presentation

5.1 Unit Lesson Chapter 5 Unit III PowerPoint Presentation

Required Unit Resources Chapter 5: Coded Data

Unit Lesson Medical coding is an essential piece of the patient discharge process as it completes one stage of the health care delivery process and gets the ball rolling into the next stage. Coding is defined as the assignment of character values that are grouped in certain ways to identify specific diagnoses and procedures (Davis & LaCour, 2017). While the primary use for medical coding is medical billing, including payment and reimbursement, this coding data can also be used for a multitude of other reasons. Coded information can be used to determine trends in diagnoses that, in turn, help with forecasting and planning. Having this type of information at their disposal, health professionals can strategically prepare to fight off an epidemic or even prevent one from occurring. Not only can medical coding data be used for research, but it can also be used in other nonclinical ways such as measuring outcomes for audit or assessment purposes, reporting required information to accrediting bodies, and/or determining productivity baselines. The American Health Information Management Association (AHIMA) has been a pioneer, not only in the HIM arena but also in medical coding practices. Evidence of this initiative comes in the form of the Standards of Ethical Coding published by the organization in an effort to guide professional coders in the right direction when it comes to correct coding. The Health Insurance Portability and Accountability Act (HIPAA) is also a governing body when it comes to code sets. HIPAA’s Standards for Code Sets puts forth guidelines as to how clinical coded data is transmitted from one entity to another entity. Code set transmissions must be secure, and information must only be assessed by those who will be using the data for meaningful purposes. HIPAA

UNIT III STUDY GUIDE

Classification and Code Sets

HTH 1304, Health Information Technology and Systems 2

UNIT x STUDY GUIDE

Title

has implemented these regulations to further advance the coding field as well as to ensure that patient’s information is safeguarded and protected as it flows from one institution to the next. Code sets come in two types: nomenclature and classification. Nomenclature medical coding is basically a system of naming health care activities or procedures in order to stay consistent in electronic communication (Davis & LaCour, 2017). Examples of nomenclature code sets would be the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT). In each of these coding sets, the selected code is related to a specific definition, and no other code will be related to that definition. We will go over a few examples later to show how the coding is unrelated to other codes in that coding set. Classification medical coding would be the opposite of nomenclature as the coding is interrelated and may build on other codes. The task of classification coding is to categorize codes, hence creating a relationship between them. Unlike nomenclature coding, classification code sets have related subcategories and sub-terms which create a sequence that helps coders code more specifically. The