Author: Piyush Goel
“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.”
What is Medical Coding?
Medical coding is something that is related to ‘Translation’. In Simple terms, medical coding is the translation of medical terms for diagnoses and procedures into code numbers from a standardized set of codes. Coders lay hold of medical reports from medical practitioners, which may include a patient’s condition, the doctor’s diagnosis of any disease or injury, a prescription, and procedures provided by the doctors to the patients. In medical coding, the information is converted into a set of codes that describes diagnoses and processes for the patients.
According to the American Academy of Professional Coders (AAPC), “Medical coding is the transformation of healthcare diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes.”
It is also referred as the process of billing insurance companies using a set of industry-standard codes. It would be nearly impossible for healthcare benefits to be properly reimbursed if they relied on insurance providers who are unskilled in the medical field to read and process a medical practitioner’s notes.
Types of medical codes in healthcare
At present, there are two different types of medical codes mainly used in healthcare settings: International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT). Although there are some differences between these classification systems, their end purpose is similar which is to allow for uniform documentation between medical facilities. Having this standard system allows for a smoother transfer of medical records, streamlined billing, and more effective research and analysis to track health trends and records.
Objectives of Medical coding
Figure 1: Different objectives of medical coding in healthcare settings
Medical coders are responsible for translating physicians’ reports into accessible and uniform medical codes. These professionals work behind the scenes in a variety of settings, ensuring all pertinent information is coded appropriately to maintain consistency and accuracy.
After a medical practitioner examines or diagnoses a patient, the insurance company or government provider is supposed to understand what was done to process the bill. Common language is not appropriate to give the required accurate details to insurance providers. Therefore, a set of specific codes has been established to define the medical procedures. It’s the role of a medical coder to provide this information in a standardized manner that is useful, efficient, and can be processed easily.
Medical Coding versus Billing
Although most of the people refer to billing and coding as if it is one or the other thing, in reality, billing and coding are two different career choices.
In short, medical billers and coders collectively gather information and documentation, code claims accurately so that physicians get paid in a timely manner, and follow up with payers to make sure that the money finds its way to the client’s bank account. Both jobs are crucial to the office cash flow of any healthcare provider, and they may be done by two separate people or by any single individual, depending upon the size of the office (workload) and the requirements of the working staff.
Difference between medical coders and medical transcriptionists
Medical transcriptionists take notes/dictations from doctors and other medical professionals to prepare written reports, such as patients’ charts or medical histories/backgrounds.
Like medical coders, transcriptionists must be familiar with a wide range of medical languages. Unlike medical coding, however, transcription work is unrelated to billing. Instead, their reports are used to create electronic health records (EHR) of patients and discharge summaries that are shared with other healthcare workers and, often, patients themselves.
Medical coders and transcriptionists have different tasks and purposes to fulfil which serve different audiences as well, but it can be said that both of them require similar skills on the job.
Both coders and transcriptionists need to be organized, detail-oriented, and accurate in their assigned work. A mistake in either coding or transcription can lead to larger problems in the future, like incorrect billing statements or inaccurate medical histories.
Medical coding as a Career
Process to become a medical coder
Figure 2: Basic process requirements for a medical coder
Figure 3: Skills required for a medical coder
Countries where Growth is Likely to occur
Figure 4: Countries with high demand for medical coders
Figure 5: Region-wise growth of medical coding in terms of capital
Big-Shots for medical coders in various fields
Figure 6: Top Companies and Service Providers
Medical coding in clinical trials
DATA generated in all clinical trials is recorded on data collection instruments (DCIs) called as Case Record Forms / Report Forms (CRFs). In these trials, information on Adverse Events (AE), Medical History (MH), and Concomitant Medications (CM) used in addition to the study medication are collected and recorded on relevant DCIs. In a multicentric clinical trial, there is the involvement of different investigators with ethnic backgrounds at various clinical sites. It is anticipated that due to the involvement of investigators and clinical research professionals from different regions, there are chances of recording medical/scientific data in a discrete fashion. All data generated in these trials are ultimately subjected to further analysis. It is very essential that this data gets interpreted uniformly in a standardized format. Hence medical coding is required by using standardized medical dictionaries. Data listed above like AEs, SAEs, MH, CM and any other category generally are coded. However coding AEs, SAEs, and CM is mandate in any given clinical trial.
There are several standardized medical coding dictionaries available in the market; however, few of the commonly preferred ones are listed below:
Growth Rate of Medical Coding Industry
Valued at $15.2 billion in 2019, the global medical coding market is projected to witness a CAGR of 9.6% during the forecast period of (2020–2030). The rising incidence of insurance fraud and growing demand to modernize hospital billing procedures are the key growth factors driving the medical coding industry.
Figure 7: Graph showing growth of Medical Coding Industry
Challenges of Medical Coding
For instance, the transition from ICD-9 to ICD-10 codes were necessary for achieving more clinically accurate content and less restrictive coding structure, as well as enhancing the data quality. Another good recent example is the release of emergency ICD codes in response to the COVID-19 outbreak.
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