Authoritative Coding Advice

Consistent coding and reporting require uniform application of the code sets. This is a challenge, since no two patients are the same and the context of the specific encounter (as well as the actual documentation provided) must be considered when applying medical codes. As a result, coding professionals seek advice on correctly applying codes to a particular patient encounter. However, only the governing body responsible for maintaining the code set has the authority to provide advice on how to apply the code set. Coding professionals should be familiar with the process and official sources established for each code set standard.

Authoritative Advice for ICD-9-CM

The Official ICD-9-CM Guidelines for Coding and Reporting were developed and approved by the four organizations making up the Cooperating Parties for the ICD-9-CM. AHIMA is one of these four parties, along with the American Hospital Association (AHA), the Center for Medicare and Medicaid Services (CMS), and the National Center for Health Statistics (NCHS). These guidelines should be used as a companion document to the official version of the ICD-9-CM code set. The ICD-9-CM Official Guidelines for Coding and Reporting are typically included in the front of most ICD-9-CM code books; however the most recent, official version is posted on the NCHS Web site

Coding Clinic for ICD-9-CM provides interpretation and coding guidance on the proper use of ICD-9-CM. This quarterly resource is published by the AHA, subscription information is available on the AHA Web site. However, the Cooperating Parties—which include AHIMA—have final approval of the content of this official publication. The Editorial Advisory Board for Coding Clinic for ICD-9-CM is a voluntary advisory board. An AHIMA representative serves on this board.

Authoritative Advice for Current Procedural Terminology (CPT) and HCPCS:

Guidelines for assigning correct CPT codes are embedded in the CPT code set via explanatory notes and remarks at the chapter level and within sections and subsections of the code set.

The AHA Coding Clinic for HCPCS provides further coding guidance on the proper use of CPT codes for hospital reporting and some HCPCS Level II codes. The Editorial Advisory Board for Coding Clinic for HCPCS is a voluntary advisory board, an AHIMA representative serves on this Board. Subscription information is available on the AHA Web site.

CPT® Assistant, a monthly newsletter from the AMA, provides coding advice for using CPT to report professional services for healthcare providers, such as physicians. The goal of the CPT Assistant Editorial Board is to take an active role in responding to "real world" coding issues to help resolve differences in opinion on correct CPT code assignment. Subscription information is available on the AMA Web site.