Medical Coding Services

Accurate medical coding is a critical component of any medical practice, and is at the heart of the practice billing process. Without proper coding, a practice can lose considerable amounts of money and may even face fines and penalties when codes are repeatedly used incorrectly.

What is medical coding?

In simple terms, medical coding is like a translation service that allows medical practices and payers to communicate in a common “language". While a medical file typically uses words to describe procedures, diagnoses, diseases and health conditions, in order to receive payment from a payer, the practice must use an alphanumeric code to let the payer know why specific charges are being submitted.

The medical coding system is incredibly complex; in order for the system to accurately reflect as many diseases, illnesses and conditions as possible, the International Classification of Diseases' ninth revision (ICD-9) - the book that contains all the current codes used in medical practices across the country - has about 14,000 codes and the next iteration, ICD-10, has roughly 18,000. Coders also rely on the Current Procedural Terminology (CPT) text when coding. The CPT is an additional code system comprising almost 10,000 codes established and maintained by the American Medical Association that describes services that are performed by a clinician.

Using medical codes is an essential part of the medical billing process for any practice. Each time a new or existing patient is seen by physician or other healthcare provider, the medical coder must assign the correct codes to that visit in order for the practice to be reimbursed for services that have been performed. When codes are used improperly, billing can be delayed or claims can be denied; in some cases, improper use of codes can even trigger a practice audit which may result in fines being assessed.

Because coding is such a complex process, medical coders must undergo rigorous training with extensive coursework to understand the coding system and to learn how to correctly use and apply ICD codes. Coders are also trained in anatomy and medical terminology so that they are able to read patient charts and accurately abstract the information needed to determine the correct codes to apply to each visit or procedure. In addition, coders must be familiar with a wide range of insurance plans and their coding and billing submission requirements, as well as the regulations and compliance rules that apply to the coding process.

What’s more, because coding evolves as new medical procedures and diagnoses are being made, coders must remain up-to-date on new systems and codes in order to remain in compliance.

Much of the information is contained within three hefty tomes which are a critical part of the coder’s curriculum: Current Procedural Terminology (CPT), the Healthcare Common Procedure Coding System (HCPCS) and the current International Classification of Diseases (ICD) code book.

 

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