Instructor Manual: Mary Jo Bowie, Understanding ICD-10-CM and ICD-10-PCS: A Worktext, 2026e, ©2027, 9798214482200; Chapter 1:
Introduction to Coding and Coding Professions
Instructor Manual
Mary Jo Bowie, Understanding ICD-10-CM and ICD-10-PCS: A Worktext,
2026e, ©2027, 9798214482200; Chapter 1: Introduction to Coding and Coding Professions
TABLE OF CONTENTS
Purpose and Perspective of the Chapter......................................................................2
Chapter Objectives........................................................................................................2
What’s New in This Edition.........................................................................................2
Chapter Outline.............................................................................................................3
Additional Resources....................................................................................................6
Internet Resources......................................................................................................................................6
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
, Instructor Manual: Mary Jo Bowie, Understanding ICD-10-CM and ICD-10-PCS: A Worktext, 2026e, ©2027, 9798214482200; Chapter 1:
Introduction to Coding and Coding Professions
PURPOSE AND PERSPECTIVE OF THE CHAPTER
The purpose of this chapter is to provide a comprehensive overview of key aspects related to medical
coding. It begins by describing the purpose of coding and its role in healthcare documentation. The
chapter then explains the development and significance of the ICD classification system. It discusses the
standards mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which
impact coding practices. Additionally, the chapter outlines various professional associations, detailing
their certifications, requirements, and objectives. Finally, it identifies employment opportunities for
coders, offering insights into career prospects within the field.
CHAPTER OBJECTIVES
The following objectives are addressed in this chapter:
1. Describe the purpose of coding.
2. Explain the development of the ICD classification system.
3. Discuss the standards mandated by the Health Insurance Portability and Accountability Act of 1996.
4. Describe professional associations with reference to their certifications, requirements, and purpose.
5. Identify the employment opportunities for coders.
[return to top]
WHAT’S NEW IN THIS EDITION
The following elements are improvements in this chapter from the previous edition:
The most current code sets available at the time of publication.
Updated information from the 2026 ICD-10-CM and ICD-10-PCS Official Guidelines for Coding
and Reporting.
Updated AHIMA link
[return to top]
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 2
accessible website, in whole or in part.
, Instructor Manual: Mary Jo Bowie, Understanding ICD-10-CM and ICD-10-PCS: A Worktext, 2026e, ©2027, 9798214482200; Chapter 1:
Introduction to Coding and Coding Professions
CHAPTER OUTLINE
I. Introduction (LO 1)
i. Medical coding is the assignment of numeric or alphanumeric digits and
characters to specific diagnostic and procedural phrases. This coding, like any other
language, needs to be translated to be understood, and each combination of
numbers or of numbers and letters represents a diagnostic or procedural phrase.
ii. By using ICD-10-CM and ICD-10-PCS codes, health care professionals can
effectively collect, process, and analyze diagnostic and procedural information
II. Professional Coding (LO 1)
i. A comprehensive understanding of medical coding, the “language” used by
insurance companies and healthcare providers to process medical claims, is vital to
the care and treatment rendered to the patient. codes are also used to collect
information that is used
for various purposes by hospitals, health departments and governmental
organizations for various purposes. Skills needed by coder to be successful are:
Attention to Detail
a) A skill involving careful and thorough focus on capturing
elements in medical documentation
with precision and accuracy.
Communication
a) Abilities to effectively and accurately interact with healthcare
providers and other members of the healthcare team ensures
success in obtaining clarification to obtain accurate codes.
ICD-10 knowledge
a) Medical coders maintain constant awareness of annual updates to
ICD-10-CM and ICD-10-PCS guidelines and codes.
Problem solving
a) Medical coders must be able to select the proper codes for
complex healthcare delivery situations that are not always clear-
cut.
Time Management
a) Abilities to meet deadlines are essential to ensure timely
submission of claims through efficient establishment of priorities
in management of
their workflow.
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 3
accessible website, in whole or in part.
, Instructor Manual: Mary Jo Bowie, Understanding ICD-10-CM and ICD-10-PCS: A Worktext, 2026e, ©2027, 9798214482200; Chapter 1:
Introduction to Coding and Coding Professions
III. History of Coding (LO 2)
a. ICD-10-CM stands for the International Classification of Diseases, Tenth Revision,
Clinical Modification. It is a coding system used in the United States for diagnosing and
classifying diseases and health conditions.
b. ICD-10 is used throughout the world as a standard diagnostic tool for epidemiology,
health management, and clinical purposes.
c. The International Classification of Diseases (ICD) was first established by the WHO. The
system undergoes revisions every decade.
d. ICD-10 was published by WHO in 1992 to address the need for a more detailed and
precise classification system. In the U.S., this led to the development of ICD-10-CM, a
clinical modification to better meet the needs of American healthcare practices. The
National Center for Health Statistics (NCHS) began testing ICD-10-CM in the late 1990s.
After field tests and modifications, ICD-10-CM was officially adopted in the U.S., with
implementation initially planned for 2013 but eventually set for October 1, 2015.
IV. Health Insurance Portability and Accountability Act of 1996 (LO 3)
i. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) aimed
to enhance the portability and continuity of health care coverage and established
standards for the electronic exchange of health care data.
ii. HIPAA mandated that ICD-9-CM diagnostic codes must be reported for
diagnoses for all levels of care, including all hospital services, clinic services,
long-term care, and physician offices.
iii. Under HIPAA, ICD-9-CM codes were used for reporting diagnoses and
procedures across various health care settings, influencing payment and medical
necessity determinations.
iv. On October 1, 2015, ICD-10-CM and ICD-10-PCS codes replaced ICD-9-CM
codes for inpatient facilities, while ambulatory and physician services adopted
ICD-10-CM codes for diagnoses and continued using CPT codes for procedures.
V. Professional Coding Associations (LO 4)
a. American Health Information Management Association (AHIMA):
i. AHIMA represents health information professionals who manage, organize,
process, and manipulate patient data.AHIMA offers a number of certifications
and credentials to ensure that its members meet the level of proficiency needed
by educated professionals to manage health care information
CCA—Certified Coding Associate
CCS—Certified Coding Specialist
CCS-P—Certified Coding Specialist, Physician-Based
CDIP—Certified Documentation Improvement Practitioner
CHDA—Certified Health Data Analyst
CHPS—Certified in Healthcare Privacy and Security
RHIA—Registered Health Information Administrator
RHIT—Registered Health Information Technician
b. American Academy of Professional Coders (AAPC)
i. AAPC was founded to elevate the standards of medical coding. The AAPC
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 4
accessible website, in whole or in part.
Introduction to Coding and Coding Professions
Instructor Manual
Mary Jo Bowie, Understanding ICD-10-CM and ICD-10-PCS: A Worktext,
2026e, ©2027, 9798214482200; Chapter 1: Introduction to Coding and Coding Professions
TABLE OF CONTENTS
Purpose and Perspective of the Chapter......................................................................2
Chapter Objectives........................................................................................................2
What’s New in This Edition.........................................................................................2
Chapter Outline.............................................................................................................3
Additional Resources....................................................................................................6
Internet Resources......................................................................................................................................6
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
, Instructor Manual: Mary Jo Bowie, Understanding ICD-10-CM and ICD-10-PCS: A Worktext, 2026e, ©2027, 9798214482200; Chapter 1:
Introduction to Coding and Coding Professions
PURPOSE AND PERSPECTIVE OF THE CHAPTER
The purpose of this chapter is to provide a comprehensive overview of key aspects related to medical
coding. It begins by describing the purpose of coding and its role in healthcare documentation. The
chapter then explains the development and significance of the ICD classification system. It discusses the
standards mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which
impact coding practices. Additionally, the chapter outlines various professional associations, detailing
their certifications, requirements, and objectives. Finally, it identifies employment opportunities for
coders, offering insights into career prospects within the field.
CHAPTER OBJECTIVES
The following objectives are addressed in this chapter:
1. Describe the purpose of coding.
2. Explain the development of the ICD classification system.
3. Discuss the standards mandated by the Health Insurance Portability and Accountability Act of 1996.
4. Describe professional associations with reference to their certifications, requirements, and purpose.
5. Identify the employment opportunities for coders.
[return to top]
WHAT’S NEW IN THIS EDITION
The following elements are improvements in this chapter from the previous edition:
The most current code sets available at the time of publication.
Updated information from the 2026 ICD-10-CM and ICD-10-PCS Official Guidelines for Coding
and Reporting.
Updated AHIMA link
[return to top]
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 2
accessible website, in whole or in part.
, Instructor Manual: Mary Jo Bowie, Understanding ICD-10-CM and ICD-10-PCS: A Worktext, 2026e, ©2027, 9798214482200; Chapter 1:
Introduction to Coding and Coding Professions
CHAPTER OUTLINE
I. Introduction (LO 1)
i. Medical coding is the assignment of numeric or alphanumeric digits and
characters to specific diagnostic and procedural phrases. This coding, like any other
language, needs to be translated to be understood, and each combination of
numbers or of numbers and letters represents a diagnostic or procedural phrase.
ii. By using ICD-10-CM and ICD-10-PCS codes, health care professionals can
effectively collect, process, and analyze diagnostic and procedural information
II. Professional Coding (LO 1)
i. A comprehensive understanding of medical coding, the “language” used by
insurance companies and healthcare providers to process medical claims, is vital to
the care and treatment rendered to the patient. codes are also used to collect
information that is used
for various purposes by hospitals, health departments and governmental
organizations for various purposes. Skills needed by coder to be successful are:
Attention to Detail
a) A skill involving careful and thorough focus on capturing
elements in medical documentation
with precision and accuracy.
Communication
a) Abilities to effectively and accurately interact with healthcare
providers and other members of the healthcare team ensures
success in obtaining clarification to obtain accurate codes.
ICD-10 knowledge
a) Medical coders maintain constant awareness of annual updates to
ICD-10-CM and ICD-10-PCS guidelines and codes.
Problem solving
a) Medical coders must be able to select the proper codes for
complex healthcare delivery situations that are not always clear-
cut.
Time Management
a) Abilities to meet deadlines are essential to ensure timely
submission of claims through efficient establishment of priorities
in management of
their workflow.
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 3
accessible website, in whole or in part.
, Instructor Manual: Mary Jo Bowie, Understanding ICD-10-CM and ICD-10-PCS: A Worktext, 2026e, ©2027, 9798214482200; Chapter 1:
Introduction to Coding and Coding Professions
III. History of Coding (LO 2)
a. ICD-10-CM stands for the International Classification of Diseases, Tenth Revision,
Clinical Modification. It is a coding system used in the United States for diagnosing and
classifying diseases and health conditions.
b. ICD-10 is used throughout the world as a standard diagnostic tool for epidemiology,
health management, and clinical purposes.
c. The International Classification of Diseases (ICD) was first established by the WHO. The
system undergoes revisions every decade.
d. ICD-10 was published by WHO in 1992 to address the need for a more detailed and
precise classification system. In the U.S., this led to the development of ICD-10-CM, a
clinical modification to better meet the needs of American healthcare practices. The
National Center for Health Statistics (NCHS) began testing ICD-10-CM in the late 1990s.
After field tests and modifications, ICD-10-CM was officially adopted in the U.S., with
implementation initially planned for 2013 but eventually set for October 1, 2015.
IV. Health Insurance Portability and Accountability Act of 1996 (LO 3)
i. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) aimed
to enhance the portability and continuity of health care coverage and established
standards for the electronic exchange of health care data.
ii. HIPAA mandated that ICD-9-CM diagnostic codes must be reported for
diagnoses for all levels of care, including all hospital services, clinic services,
long-term care, and physician offices.
iii. Under HIPAA, ICD-9-CM codes were used for reporting diagnoses and
procedures across various health care settings, influencing payment and medical
necessity determinations.
iv. On October 1, 2015, ICD-10-CM and ICD-10-PCS codes replaced ICD-9-CM
codes for inpatient facilities, while ambulatory and physician services adopted
ICD-10-CM codes for diagnoses and continued using CPT codes for procedures.
V. Professional Coding Associations (LO 4)
a. American Health Information Management Association (AHIMA):
i. AHIMA represents health information professionals who manage, organize,
process, and manipulate patient data.AHIMA offers a number of certifications
and credentials to ensure that its members meet the level of proficiency needed
by educated professionals to manage health care information
CCA—Certified Coding Associate
CCS—Certified Coding Specialist
CCS-P—Certified Coding Specialist, Physician-Based
CDIP—Certified Documentation Improvement Practitioner
CHDA—Certified Health Data Analyst
CHPS—Certified in Healthcare Privacy and Security
RHIA—Registered Health Information Administrator
RHIT—Registered Health Information Technician
b. American Academy of Professional Coders (AAPC)
i. AAPC was founded to elevate the standards of medical coding. The AAPC
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 4
accessible website, in whole or in part.
