Medical Coding Process

A shortcut to the healthcare terminology

Author: Vaishali Karmalkar

We all know what coding Is, but it is strange sometimes to use coding language in the Pharmaceutical Industry. Today we prefer Medical coding in the Healthcare sector for transforming healthcare diagnosis, Procedures, medical services, and equipment into Universal medical Alphanumeric codes. Medical coding is performed worldwide using the International classification of disease(ICD). Medical coders study the clinical statements and assign standard codes using the Current Procedural Terminology (CPT), ICD-10-CM, and Healthcare Common Procedure Coding System (HCPCS) Level II Classification system. In short, Medial codes serve as a language between Providers and Payers.

Medical coding Process

Medical billers and coders keep Patient records current and Accurate. It acts as a bridging gap between Clinical Care and administration. Medical coder Professionals review Diagnoses, test results, procedures, and other information and form an assigned code. Medical billers enter the code onto the bills in the proper order. Then they submit it to Insurance companies which review the categorization of procedures or treatment and reimburse providers according to the terms of the coverage plan.

Medical coding and Audit services

1. Get Medical Records from the Client via a secure connection.
2. Validate the correctness of Information.
3. Review the Records and assign the Information.
4. Audit of coded charts by the QA Team.
5. Send a completion report to the customer.

Accurate Medical coding can reduce claim details.

Medical coding and Medical billing

Medical coding and Medical Billing are distinct jobs. Medical coding converts Patient records into alphanumeric codes whereas Medical billing is the financial aspect of submitting data to Insurance companies. Thereby they are the backbone of the healthcare revenue cycle, Ensuring payers and Patients reimburse providers for services delivered.

TYPE OF CODES

Standardized Medical codes Provide information about the Patient’s diagnosis, Medical necessities for treatments, services or supplies the patient received, Treatments, services, and supplies provided to the Patient, and any unusual circumstances or medical conditions that affected those treatments and services.

1. ICD code indicates the Patient’s condition, Location, Severity of Symptoms, and if a visit is related to an initial or subsequent encounter.
2. ICD-10-CM (Clinical Modification) codes classify diagnosis in all healthcare settings.

It contains over 70000 ICD codes.

3. ICD-10-PCS (Procedure Coding System) codes for inpatient services at Hospitals.
4. CPT codes indicate if Providers performed multiple procedures.

It contains over 10,471 CPT codes.

5. HCPCS describes non-physician services such as ambulance rides, durable medical equipment, and Prescription drug use.

Charge capture codes: Coders connect Physician order entries, Patients care services, and other clinical items with a chargemaster code i.e. it is a collection of standard prices for services and items that a provider organization offers.

Computer-assisted coding (CAC) solutions can help speed up the medical coding process and increase coding accuracy and efficiency.

Code assigned,

For Evaluating Patient: CPT = 99285

ICD = K35.80

For Procedure: CPT = 44950

ICD = K35.80

The medical coder should have Industry specific skills such as ICD-10 coding, CPT coding, HCPCS coding, Medical terminology, Anatomy, Healthcare regulations, etc., and Professional skills such as Communication, critical thinking, Time management, Attention to detail, Research, and computer literacy.

Quintessence is a leading Revenue cycle management services and technology company offering performance-guaranteed and effective solutions to Medical billing and Medical coding companies.

Medical coding has a Financial aspect. It is also a huge part of studies and Research about diseases and treatments. Medical coding data analyzed the pattern of diseases in society, which helps the government understand how to come up with Programs that combat these diseases. Although medical coders don’t save lives in the way Healthcare Providers do, their contributions are vital to ensuring the continuity of Patient care and also play a role in keeping the healthcare providers in Business and available to all.

So keep your enthusiasm high to acknowledge us as a MEDICAL CODER.

References:

https://www.aapc.com/medical-coding/medical-coding.aspx

https://revcycleintelligence.com/features/exploring-the-fundamentals-of-medical-billing-and-coding

https://www.cigmahealthcare.in/news/basic-working-of-medical-billing-and-coding-process