What Is Medical Coding?
Medical coders are fundamental to medical record keeping and essential to
the medical practice's existence. A healthcare provider who delivered a medical service to a patient or client
is entitled to receive money for these services. Accurate medical coding is just as critical to get paid as
timely filing a claim with the patient's health insurance, or managed care organization.
Medical coding involves identifying a medical service that was provided from the patient's
medical record, or the superbill, and assigning a numerical code that corresponds with this service. Coders need to
know how to code for specific insurance companies within their established policies and applicable laws and
regulations. It is a systematic process that can get complicated.
What Medical Coders Do
Many see medical billing and medical coding as two distinct disciplines, however, both embrace so many facets
that overlap, or go hand-in-hand, that one couldn't exist without the other. The art of medical
coding cannot be learned through using software, it is learned by listening to the instructor, taking
notes, opening the CPT/ICD-10 books and using your mind to code through practice, practice, and practice. You don't
succeed by using software as your main tool. You learn and succeed through hard work.
Although the medical coding process somewhat resembles looking up a name and phone number
in a telephone book it is not as simple as it may sound. And although medical coders work hand-in-hand with medical
billers, the experts in the field feel strongly that medical billers should not code unless trained to do so and
with proper professional liability insurance in place.
KNOWLEDGE OF INSURANCE CLAIM AND REGULATORY CONSIDERATIONS. New patient
interview and check-in procedures; established patient return visits; post-clinical check-out;
computerized practice procedure methods.
ICD-10-CM CODING. Using the ICD-10-CM coding system; primary vs. principal
diagnosis; ICD-10-CM terms, marks, abbreviations and symbols; index tables.
CPT CODING. Basic format of CPT service and procedure codes on the
CMS-1500 claim; comparing CPT with ICD-10-CM coding; modifiers; new vs. established patient; assigning
emergency department and critical care codes; consultation vs. confirmatory visit; preventive medicine
HCPCS CODING AND CMS REIMBURSEMENT. The HCPCS system for reporting
professional services, procedures, supplies and equipment; HCPCS level II coding system; CMS
reimbursement; rules of the Medicare physician fee schedule payment system.
CODING FOR MEDICAL NECESSITY. Assessment and coding from patient medical
records; securing the correct physician documentation; coding an operative report; selecting and coding
diagnoses and procedures from case studies and sample records.
Special codes exist for all types of encounters, services, tests, treatments, and procedures provided by a
healthcare provider in a medical office, hospital, or clinic. These codes are described as CPT4 codes that consist
of 5 digit numbers. Even the simplest patient complaints such as headache, or nausea have codes which consist of a
set of numbers and combinations of sets of numbers. Software is NO guarantee of 100% accuracy.
When a provider sees and treats a person seeking medical advice in the medical office or practice it is referred
to as an encounter. An encounter is defined as "a face-to-face contact between a healthcare professional and an
Medical Coding Purpose
The American Medical Association (AMS) developed the CPT coding system. CPT stands for Current
Procedural Terminology to tell the health insurance companies or government entities the reason why a patient was
seen and what services were performed so that the provider can get paid. Codes also are implemented to gather and
communicate public health statistics. Medical codes are used for a variety of purposes.
- Coding diseases and procedures
- Physician billing and reimbursement
- Recording causes of death
Surveys show that MANY medical coding positions remain unfilled due to a lack of qualified
candidates! The US Bureau of Labor Statistics states coding (as well as billing) is one of the ten fastest growing
allied health occupations. Physicians depend on well trained, reliable medical coding and billing staff because
otherwise they might not get paid for their services, or might wind up being charged large penalties due to
improper coding, which could mean financial disaster, and cost them their livelihoods. Once hired, medical coders
and billers hold secure jobs, with good futures. Supervisors spend weeks or months training medical billers and
coders one-on-one. Once they are trained and have gained experience by participating in the daily office routine,
chances are good that their positions will be long term.
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