Medical coding is an important part of the revenue cycle because it facilitates communication between providers and insurance. It encourages payers to make refunds, which necessitates precise coding. In this post, we go over the fundamentals of medical coding and discuss some of the employment options in the field, as well as the best strategies we can use to increase payments while remaining compliant.
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Understanding Medical Coding
Medical coding refers to the process of assigning universal alphanumeric numbers to healthcare services such as medical diagnoses, procedures, services, and equipment. A medical coder assigns diagnosis and procedure codes to a patient’s medical record, which includes documents such as physician’s notes, laboratory reports, and services lists. Medical coding entails extracting medical data from existing paperwork, assigning the appropriate diagnosis and treatment codes, and facilitating the production of a claim to be submitted to payers.
The following information can be gleaned from the standardized codes by payers:
- The diagnosis of the patient
- Medical necessity for the patient’s treatments, services, or supplies
Types of Medical Coding
Generally speaking, there are the following types of medical codes:
- ICD Codes
- CPT Codes
- HCPCS Codes
- DRG Codes
- Modifiers
ICD-10 Diagnosis Codes
Diagnosis codes are essential for characterizing a patient’s illness or injury, as well as socioeconomic determinants of health and other personal characteristics. For billing purposes, the sector employs the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) system.
ICD-10-CM (clinical modification) codes are used to identify illnesses across all healthcare settings, whereas ICD-10-PCS (procedure coding system) codes are used for hospital inpatient treatments.
The location and degree of an injury or symptom, as well as whether the visit is related to an original or later encounter, are all indicated by ICD codes.
The ICD-10-CM code set alone contains over 70,000 unique identifiers. The ICD coding system is maintained by the World Health Organization (WHO), and it is used internationally in various versions.
CPT Codes
The Current Procedural Terminology (CPT®) codes provide doctors and other healthcare workers with a common language for coding medical services and procedures, making reporting easier and more accurate.
CPT codes are also used for administrative management objectives, like as claims processing and setting criteria for medical care evaluation.
CPT is the most commonly used medical nomenclature for reporting medical, surgical, radiological, laboratory, anesthesiology, genomic sequencing, evaluation and management (E/M) services under public and private health insurance plans across the country.
CPT codes are all five digits long, and depending on the category, they can be numeric or alphanumeric. CPT code descriptors are clinically focused and apply common standards to provide a shared understanding across the clinical health care paradigm for a varied group of users.
HCPCS Codes
Another coding system used in the United States is the HCPCS (Healthcare Common Procedure Coding System) levels I and II. Medicare and Medicaid patients are billed using HCPCS codes. The Healthcare Common Procedure Coding System (HCPCS) is a set of codes that describe procedures, supplies, products, and services that can be supplied to Medicare recipients and people with private health insurance.
DRG Codes
DRG Codes (Diagnosis Related Group) is a technique for categorizing hospital cases into one of about 500 groups, also known as DRGs, that are predicted to require similar hospital resources. Because most insurance companies compensate based on the DRG utilized, accuracy of all components is critical to receiving correct compensation.
Modifiers
CPT modifiers (also known as Level I modifiers) are used to enhance or amend care descriptions to provide additional information about an operation or service provided by a physician. Code modifiers allow you to expand on a procedure code’s definition without modifying it. Often, HCPCS codes are also used as modifiers. These codes, comprising of two-digit alphanumeric characters, provide additional information about the medical procedure performed.
The Significance of Medical Coding
Thoroughly documenting what was learned, agreed, and done is the foundation of the healthcare income stream. A patient’s diagnosis, test findings, and treatment must be documented not only for compensation but also to ensure high-quality care in future visits.
Personal health information about a patient accompanies them through subsequent complaints and treatments, and it must be easy to understand. This is especially critical in light of the hundreds of millions of visits, operations, and hospitalizations that occur in the United States each year.
However, there are thousands of ailments, diseases, injuries, and causes of mortality to consider. Thousands of services are provided by providers, as well as an equivalent number of injectable medications and supplies that must be recorded. Medical coding categorizes these items to make reporting and monitoring easier.
And in healthcare, there are various descriptions, acronyms, names, and eponyms for each disease, process, and tool. Medical coding standardizes the language and presentation of all of these components, making them easier to comprehend, maintain, and modify. The Health Insurance Portability and Accountability Act (HIPAA) requires hospitals, providers, and payers to use a single language to communicate effectively and consistently.
Get Started with Medical Coding Today!
Are you looking to hire a medical coding company for delivering comprehensive services suited to your organization? Or are you someone trying to build a career in medical coding and don’t know where to start? Medical coding as a profession is only gaining more and more prominence with time. The COVID-19 pandemic has fueled the need for reliable, accurate medical coding, bringing the profession in limelight. It is only set to grow further with time as an integral component of healthcare revenue cycle processes, ensuring higher quality patient care and delivery.
