Friday, June 1, 2012

Medical Coding

What is Medical Coding?

Medical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers. The diagnoses and procedures are usually taken from a variety of sources within the health care record, such as the transcription of the physician's notes, laboratory results, radiologic results, and other sources.

Diagnosis codes are used to track diseases and other health conditions, whether they are chronic diseases such as diabetes mellitus and heart disease, to contagious diseases such as norovirus, the flu, and athlete's foot. These diagnosis and procedure codes are used by government health programs, private health insurance companies, workers' compensation carriers and others.

Medical classification systems are used for a variety of applications in medicine, public health and medical informatics, including:

  • statistical analysis of diseases and therapeutic actions
  • reimbursement; e.g., based on diagnosis-related groups
  • knowledge-based and decision support systems
  • direct surveillance of epidemic or pandemic outbreaks

What does a Medical Coder do?

Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The Coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS.

A medical billing coder analyzes patient charts and assigns the appropriate medical diagnosis codes and CPT medical billing codes. These codes are derived from ICD-9 codes and corresponding CPT treatment codes and any related CPT modifiers. Some medical billing and coding specialists obtain some type of certification from a recognized professional organization. In general the more certifications the greater the income potential. Proper coding is very important to getting fairly reimbursed.

Good coding complements the billing process and insures the provider is getting fairly compensated. Even if you want to stick strictly to medical billing, having a basic understanding of what the medical coding specialist does is important. If you are a biller, the more you can learn about coding, the more valuable you are to a practice or billing company. Most small practices don't have dedicated coders or billers - they multi-task and may perform limited coding functions in addition to billing.

The medical billing specialist really needs to know enough about coding to see when the CPT medical billing coding are not compatible with the ICD 9 codes. For smaller practices the provider may do their own coding and the medical billing specialist acts more to identify out of date codes so the provider can correct them. Most practices use a lot of the same CPT and ICD-9 codes so once you become familiar with the codes and medical billing modifiers, you've conquered the most difficult part. The most commonly used ones may be listed on the practice superbill.

For family or internal medicine practices, you may see a wider variety of codes and modifiers than for specialty providers. My medical billing company serves smaller practices that may need coding services, so we offer medical coding services to complement our billing services. Many medical billers prefer to stay strictly with medical billing services and that's great. But if you can become proficient in coding - even if you are not an expert - you're much more valuable to a provider.


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  2. Thanks for sharing valuable information. I would like to add some more points; Accuracy in Medical Coding would be a most important factor for Medical practitioners to maintain the business account receivables effectively. The accounts receivable service professionals maintain the every phases of healthcare business operations with more accuracy.