What is Medical Coding?
Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc. Medical coding professionals help ensure the codes are applied correctly during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers.
Medical coding happens every time you see a healthcare provider. The healthcare provider reviews your complaint and medical history makes an expert assessment of what’s wrong and how to treat you and documents your visit. That documentation is not only the patient’s ongoing record, it’s how the healthcare provider gets paid.
Medical codes translate that documentation into standardized codes that tell payers the following:
- Patient’s diagnosis
- Medical necessity for treatments, services, or supplies the patient received
- Treatments, services, and supplies provided to the patient
- Any unusual circumstances or medical conditions that affected those treatments and services
Like a musician who interprets the written music and uses their instrument to produce what’s intended, Medical Coding requires the ability to understand anatomy, physiology, and details of the services, and the rules and regulations of the payers to succeed.
Medical coding derives from public bills of mortality posted in London in the 18th century. It was through correlating these that doctors determined the cause of a cholera epidemic. It is even more vital now as the data gathered through Medical Coding is used to improve healthcare overall. The results are submitted to payers for reimbursement, but the data derived from the codes also are used to determine utilization, manage risk, identify resource use, build actuarial tables, and support public health and actions.
The Medical Coder and biller process a variety of services and claims daily. Medical codes must tell the whole story of the patient’s encounter with the physician and must be as specific as possible in capturing reimbursement for rendered services. To better understand what a coding transaction looks like, read the article
“What Does a Medical Coder Do?”
The main task of a Medical Coder is to review clinical statements and assign standard codes using CPT®, ICD-10-CM, and HCPCS Level II classification systems. Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The Medical Coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To help promote a smooth coding and billing process, the coder checks the patient’s medical record (i.e., the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies, and other sources) to verify the work that was done. Both work together to avoid insurance payment denials.
The challenge, however, is that there are thousands of conditions, diseases, injuries, and causes of death. There are also thousands of services performed by providers and an equal number of injectable drugs and supplies to be tracked. Medical coding classifies these for easier reporting and tracking. And in healthcare, there are multiple descriptions, acronyms, names, and eponyms for each disease, procedure, and tool. Medical coding standardizes the language and presentation of all these elements so they can be more easily understood, tracked, and modified.
This common language, mandated by the Health Information Portability and Accountability Act (HIPAA), allows hospitals, providers, and payers to communicate easily and consistently. Nearly all private health information is kept digitally and rests on the codes being assigned.
Medical Coding & Billing: A Common Problem
A medical coder earns their living by typing patient medical information into large databases. There are two types of medical coders: ones that work for hospitals and others that work for insurance companies and self-employed coders. Medical coding is considered a lucrative career these days because healthcare costs are soaring. This career can be done from home or at an office depending on one’s convenience. A person needs to be knowledgeable about medical terms and terminology to become a successful medical coder. It is necessary to have a thorough knowledge of the medical code system to be certified.
Health Care Industry Demand
The healthcare industry has seen a huge demand for licensed medical coders in recent years. They are responsible for assigning healthcare procedure codes to diagnoses, procedures, medical equipment, and laboratory and imaging products for a wide range of healthcare facilities. Medical Coding Technicians work under the guidance of Registered Health Information Managers (RHIMs) and Medical secretaries. Both of them are required to undergo training to become Certified Medical Coder (CMIC).
A growing number of healthcare practitioners are now taking on the role of inpatient coders and provide their patients with access to quality health information. A number of software programs have been developed to help healthcare providers keep track of patients’ records. Some have been designed to integrate seamlessly with existing computerized systems. In addition, there are several software programs specifically designed for in-home use. To meet the needs of the expanding number of health care practitioners, a number of third party vendors are providing software programs designed to meet the specific needs of this rapidly expanding industry.