Medical coding
Medical coding is a crucial component of the medical billing process within healthcare administration. It involves the categorization of medical procedures, diagnoses, and services into specific codes used for billing and tracking by healthcare providers. Medical coders, who may also be referred to as clinical or diagnostic coders, must possess a strong understanding of anatomy, medical terminology, and healthcare regulations, as well as obtain certifications like the Certified Professional Coder (CPC) from recognized organizations.
In the United States, medical coding typically involves three primary coding systems: Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases (ICD). CPT codes are used for billing services performed by physicians, while HCPCS codes encompass a broader range of medical services and supplies, particularly for Medicare patients. ICD codes are essential for documenting patient diagnoses and are used globally to track public health data.
Medical coders play a vital role in ensuring the accuracy of codes assigned to procedures and diagnoses, facilitating timely and correct reimbursement for healthcare providers. They usually work in various healthcare settings, such as hospitals and clinics, and primarily handle paperwork rather than direct patient interaction. As technology continues to evolve in the medical field, the role of medical coders is expected to adapt accordingly.
Medical coding
Medical coding is a step in the medical billing process in the field of health care administration. All medical procedures are categorized by specific codes. Medical coders use these codes to identify which procedures a physician has performed for billing and tracking purposes. In addition to learning all of the different medical codes, medical coders must be familiar with the fields of anatomy and physiology; medical procedures, terminology, and jargon; and insurance plans, regulations, and compliance. Medical coders (also known as clinical coders or diagnostic coders) often must obtain some form of official certification or accreditation, such as Certified Professional Coder (CPC) credentials from the American Academy of Professional Coders (AAPC) in the US health care system, although requirements vary between jurisdictions.
Types of Medical Codes
In the US health care system, most medical coders use three types of medical codes: Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases (ICD). The codes identify the types of procedures performed by a physician; the physician's diagnosis of the patient; and the devices, equipment, and supplies used during the visit. In the United States, the Centers for Medicare and Medicaid Services (CMS) regulates the health care coding system under the Health Insurance Portability and Accountability Act (HIPAA).
CPT
CPT codes are five-digit codes that refer to the procedures or services (medical, surgical, and diagnostic) performed by a doctor on a patient. Health insurance companies use these codes to determine the amount a doctor will be reimbursed for service. Thousands of CPT codes exist.
The American Medical Association (AMA) develops, maintains, and copyrights CPT codes. AMA revises these codes as new services are developed or old services are no longer used. If a physician gives a patient a flu shot, a medical coder would read the physician's report of services performed and assign the correct code for a flu shot (90658). Other common CPT codes include 99396 (physical checkup), 99214 (office visit), and 90716 (chicken pox vaccine). Some codes are bundled to denote several procedures performed at once.
HCPCS
HCPCS codes are two-level codes used to denote procedures or services performed by a doctor on Medicare patients as well as to cite devices, equipment, and supplies used during a doctor's visit. The Centers for Medicare and Medicaid Services (CMS) monitors these codes, and Medicare reimburses physicians and suppliers for services rendered and equipment used.
The first level of a HCPCS code is exactly the same as CPT five-digit codes and used to denote services. Physicians use this code for billing Medicare for services. The second level refers to equipment and supplies. Medical equipment suppliers, ambulance services, and more use the second part of the code for billing Medicare for supplies and equipment.
ICD
ICD codes are used to record, report, and track doctors' diagnoses of patients. The World Health Organization (WHO) develops, maintains, and copyrights these codes. It works with the National Center for Health Statistics (NCHS) to revise ICD codes. The ninth revision will be used until October 1, 2015, when the tenth revision will go into effect.
These codes are not used for billing purposes; they are used to track health conditions. Every medical diagnosis, description of symptoms, and cause of death has a code. This means a code exists for every possible human diagnosis. ICD codes are generally the same in every part of the world. The codes use three numerals followed by a decimal point and numbers. Different countries and organizations might attach additional numbers or letters to this number. For example, the ICD code for heartburn is 530.81 in the United States. If a person with this condition travels to Canada, the ICD for heartburn there is 530.81-CA. The letters "CA" are added to the end to designate Canada.
Governments and other health officials use ICD codes to track certain diseases—especially contagious ones. This helps officials learn how diseases are spread, where they are most prevalent, and what determinations to make regarding research and prevention programs. These codes also are used on death certificates to explain the cause of death.
CPT, HCPCS, and ICD medical codes work together. For example, when patients visit a doctor, their paperwork will show CPT codes for services rendered for billing purposes and ICD codes that describe the diagnoses for tracking purposes. If people are Medicare patients, their paperwork will also have HCPCS codes.
Medical Coders
A medical coder is very important to a health care practice or facility. Medical coders are responsible for reading medical records, deciphering medical terminology, assigning medical codes, and either billing a third party, such as an insurance company, or passing this information on to a medical biller. Medical coders ensure all codes are accurate and follow up on any discrepancies between physicians, hospitals, and insurance companies. The purpose of a medical coder is to ensure physicians are paid accurately and in a timely manner.
While a college degree is not mandatory, most medical coders in the United States complete medical coding courses at colleges, technical schools, or online; pass the CPC exam; and receive CPC certification through the AAPC. The AAPC also offers other specialty certifications such as Certified Professional Coder-Hospital Outpatient (COC), Certified Interventional Radiology Cardiovascular Coder (CIRCC), Certified Professional Medical Auditor (CPMA), and Certified Professional Compliance Officer (CPCO). The American Health Information Management Association (AHIMA) offers other professional coding designations such as Certified Coding Specialist (CCS) and Certified Coding Specialist-Physician-Based (CCS-P). In addition to certification, medical coders should be familiar with medical terms and the three primary types of medical codes.
Most medical coders work a traditional forty-hour, Monday through Friday schedule. They primarily work in offices at hospitals, clinics, individual or group medical practices, laboratories, nursing facilities, mental health facilities, medical equipment suppliers, and other health care facilities. They typically do not interact with patients, but they do work closely with physicians, nurses, therapists, technicians, insurance companies, and more. As technology changes the way that medical and insurance companies maintain billing and records, medical coders jobs will evolve along with them.
Bibliography
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