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Medical Coding Process

Author: Palivela Mahathi

ABSTRACT:

Medical Coding Process aims error-free diagnosis for suffering mankind, which opts the excellent careers for professionals. To assist the victims for various medical processes, claiming for reimbursement from providers, felicitous code allotment. They abstract the information from the documentation during Medical Billing Process thus assigning medical codes for specific diseases or diagnoses.

INTRODUCTION :

India’s enriched progress with the developments made particularly in Public Healthcare System, besides new version technologies fill with the standardized opportunities economically and healthy longevity. One of those development systems for authoritative disease recognition is the Medical coding system.

In recent years i.e., mid-1970s India had developed a coding system to track the health record medically. Professionalized progress and optimized skills feasting for the opportunities, laid across the world. But what do people generally expect for especially in remote areas? Explicitly, number of people look forward for health services, medical facilities and appetite the welfare of human through many circumstances in which medical coders prioritize maximally for Medical Coding Process.

History of Medical Coding Process

Medical codes started in 17^th century through “London Bills of Mortality” by John Gaunt which is a thin sheet that has a record of the death percentage, mortality rate on which diseases were arranged into code form. The major problem with these bills is it cannot be related to their terminology, showing differences than the required. The father of the Medical Coding is Jacques Bertillon and he introduced a classification known as “Bertillon Classification of Causes of Death” through which the death rate is clearly known.

After London Bills of Mortality, a Classification System was established by Dr.William Farr commonly known as “Uniform Classification System”. From this classification system he formed Statistical Congress and later on the list contained number of International deaths called “International list of Causes of Deaths”, which is later on formed in the hands of World Health Organisation (WHO).

In 1977, ICD-9 was introduced called commonly as “International Classification of Diseases” in which injuries other than deaths or some others diseases related to illness are introduced in it.

After 1980s number of handwritten copies were made and electrically preserved.

In the year 2014, ICD-10 Version was well known to which new processes were set up with new codes and procedures.

What is Medical Coding Process?

Medical Coding Process is an administrative modification from a medical record into a universal code form. In essence, ties into medical billing, creating insurance claims to the payer. Professionals executing this process are medical coders. The medical coders deal the process with the medical billing department, which is legally authorized for the payments and investments made. This process provides healthcare facilities to people of underprivileged streams in secured circumstances.

Now, there would be a question that do we actually need the doctor’s consultancy for insurance? Not totally but somehow this process requires a medical representative consultancy and the permissible filing from the insurance companies. This process includes the steps of verifying the documentation, assigning the alphanumeric codes and claim for the bill payment by the investors.

This medical coding process ensured codes should be able to elucidate the information to the doctor for a route to reimbursement to the service provided.

How is Medical Coding Process done?

Thusly, if a patient visits a doctor with the issue facing along with the beneficial data throughout the billing, after the diagnosis, during the treatment of the disease of the patient, the doctor checks out in a legal form and drive the data to the medical coder. The medical coder performs their task in certifying the universal alphanumeric codes to the patient’s type of illness.

In general, coding systems are categorized primarily into 3 systems to provide services fairly coded from 3 books

1. Current Procedural Terminology [CPT]
2. International Classification of Diseases Version 10

[ICD – 10]

3. Healthcare Common Procedural Coding System [HCPCS].

[CPT]: 1) Current Procedural Terminology

The codes in this book are helpful for surgical procedures, anesthetic administration, operational

diagnosis procedures. The codes are worldwide assigned by American Medical Association [AMA] which last 5 digits for proper efficiency and effective to each and every unique surgery utilized by the patient. Usually, there are 3 types of CPT codes.

1. CATEGORY-1 CPT CODES:

It totally depends on the type of specialization or the health care they are pertained to which are six sectioned mentioned below

1. a) Anaesthesia
2. b) Surgery
3. c) Radiology
4. d) Pathology and Laboratory
5. e) Medicine
6. f) Evaluation and Management

The codes are 5-digit numerically in a proper order for easy recognition. Since there are a vast number of codes and a demandable category for CPT medical coders they mostly spend their professional time working on the category of CPT codes. These codes an approval for Food and Drug Administration (FDA).

2. CATEGORY-2 CPT CODES:

These are alphanumeric codes which are used to track supplements provided helpful for health service management. This category codes are functional in performing measurement codes and identify patient information especially patient safety to follow the further procedure. This category codes are coded immediately after category-1 codes.

These are coded with 4-digits followed by the last letter `F’. These codes are tend to be optional, collect the health data and ultimately, reduce the doctor’s burden with regard to the administrative department by providing the clear cut effective information about health performances. The chances of using CPT category -2 codes in place of category-1 codes are fifty percent.

3. CATEGORY-3 CPT CODES:

These codes deal completely with the updating technologies and experimental technologies with the services being provided and procedures followed for it.  Though this is not permanent, but given the crucial importance. These codes are earmarked to produce the documents for approval from Food and Drug Administration (FDA) which are not compulsorily but often required. These codes are updated for every 2 years through electronic devices.

Since CPT category-3 codes do not have RVUs assigned, no establishment of payment and reimbursement depends on the judgement given to the person legally based on the given documentation.

2) International Classification of Diseases Version 10 (ICD-10):

The codes in this book are useful in coding the diseases and a reason is also reported for the patient’s treatment. This book is published by World Health Organisation (WHO). United States (US) modified the clinical medical diagnosis into two code set form as ICD-10 PCS for the patients who require hospital facilities called as inpatient where PCS meaning Procedure Coding System thereafter ICD-10 CM preferred for the patients not much hospital environment required commonly referred as outpatient and CM stands for Clinical Modification which are also used in clinical procedures. Totally 87,000 codes are available in ICD-10 PCS while 68,000 codes in ICD-10 CM. They contain not more than 7 digits as the code number.

The codes development deal not only diagnosis but also death causes. Three versions of ICDs build trifling differences in ICD-9 and ICD-10 in technology development technically updating and ICD-9 came about 3-5 numeric codes and ICD-10 enlarged for about 3-7 numeric codes.

3) Healthcare Common Procedural Coding System (HCPCS):

This system codes for healthcare supplies and equipments which are advantageous and profitable. Equipments like drugs, medicines are coded along with the ambulance services provided for the Medicare. It is an official code set developed by Centre for Medicare and Medicaid Studies (CMS) Company exclusively to create an outpatient healthier service. The HCPCS has two levels in which one is CPT codes and the following one would be alphanumeric codes. The major difference between two levels is that CPT HCPCS supplies physician stock and alphanumeric codes supplies the products not used by CPT. The code system is developed under American Medical Association (AMA) and usually updated for every 12 months. The common synonym used for this system is` hick picks.’ The CPT codes identified by five digit code and alphanumeric codes have an alphabet and a for digit code.

Medical coders benefits

• For the healthcare :

As the medical coders are fewer and the sufferer population with the discovery of new diseases is increasing it becomes quiet tough for the medical coders and completely pressurized with a loads of burden.

For inappropriate medical coding the claims are denied, cancel for reimbursement from insurance companies medical coders are liable for which the solution is to hire productive medical coders allot the right code for even the complex surgeries. And also, we exclusively allot the complex codes with the updated versions for the newly discovered surgeries, treatments, diseases etc.

Doctors on the other hand feel stress free , to have more number of medical coders as it becomes easy to get the entire lab measurements in a clear cut manner without a bit of confusion and thus able to diagnose more precisely.

• As a career

Medical coders can work under any specialisation in any field (Physician, Radiology, Surgeon, Cardiology, Ophthalmology, etc ).They usually have the limited working time or can work for odd times, part time, some night shifts, if so necessary.

They are also being offered with plenty of opportunities with much package and expectations of promotions and increments are satisfied, perhaps independent and healthy financially. If the coders are glued to this profession, they will have no fluctuations for back step nor quit.

Medical coders will have to provide with the facilities for traveling, internet connection, and a team when worked for remote or rural areas. And if work for a clinic or hospital they officially provide electronic device like computers, laptops, I pads, smart phones etc, along with the recognition deserved, appreciation, respect  from the companies, people ,society for the job they perform . Interestingly, they need not to be worried nor strive hard for years to get certified since it would be possible for six months not more than nine months through CPC Exam.

Medical coders update day to day and time wise as to know about the new diseases and new diagnosis procedures for allotting the codes. There is no word of shattering the knowing for learning. They will have to create their new versions of development through which quick grip of software is possible.

• In hospitals :

Medical coders save the doctors’ time by giving the complete health picture. Hence, the doctors need not to emphasize but just a rough glance at the medical coding report and patient’s lab report. Also reduce the cost for payment to administration as extra payment besides their work. The equipments used at the time of billing is in the hand of medical coders wholly.

Medical coders, when they are used in an incorrect manner, creates the disturbance in the entire billing process as its being prepared as per the medical coding billing process. Hospitals who have skilled coders, the perfection inscribe the codes based on the treatment or the diagnosis.

Technically, the main motive of medical department is to enhance the healthcare of the patients. But without the actual support of the medical coding team, it would not be possible. Also, due to the complex coding for which they accumulate much of the hospital’s time indirectly allowing them to care their own patient. During the treatment or prior to the doctor’s visit, sometimes to pursue the procedure from that medical representative, carry the essential information from the patients for further steps, the doctors guarantee that the patient’s particulars or the representative’s documentation are hidden from illegal and unfair activities.

The predominant reason of medical coding is the patient’s whole hearted satisfaction for the activities performed by medical coders. A medical coder task will be entirely ruined if they do not satisfy the patient. How hard they work it is the patient’s satisfaction that is the most susceptible job.

REFERENCES:

Medical Coding- Beth A Rich, Patricia Aalseth; CODING with MODIFIERS-Deborah J.Grider; Understanding Medical Coding-Sandra L.Johnson and Robin Linker;

STEP-BY-STEP Medical Coding-Carol J. Buck; Essentials of Bioinformatics and  Basics of Medical Coding-Dr.V.Senthamarai Selvi, Dr. J.Dhanalakshmi.