Medical coding, which is also referred to as medical classification, is the process where medical coders assign universal medical codes, in numeric or alphanumeric format, to medical procedures and diagnoses. To determine the procedures or diagnoses that must be coded, medical coders may refer to the patient's medical record, lab results or doctor's notes. These codes are used to track diseases and injuries and the procedures used to treat medical problems.
Medical codes are used on claim forms submitted to insurance companies, Medicare and Medicaid for reimbursement and on diagnostic request forms. They may also be used internally at health care facilities for research and marketing purposes. Those organizations that use medical coding include health care facilities, health insurance companies, the federal government and workers' compensation providers..
Correct medical coding is essential for the accurate transmission of procedures and diagnosis data between health care providers and the many insurance companies that act as third-party payers for the health care services rendered to patients.You must have the coding manuals (ICD-10-CM, CPT and HCPCS Level II) for the assignment of codes and for this course. If you don't have the coding manuals, order them now and then begin going through the course modules
Where is Medical Coding Performed?
Hospitals (Inpatient and Outpatient facilities) Physician's offices Home health care agencies Long term care facilities Insurance companies.
How is Medical Coding Accomplished?
The physician or other health care provider documents in detail about the patient's condition. Key medical terms are identified and abstracted from the medical record. Using coding manuals, specific codes are assigned to each term. Diagnosis codes and inpatient procedure codes are found in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM Volumes 1, 2).
Outpatient services and procedure codes are found in the Current Procedural Terminology (CPT) manual, copyrighted by the American Medical Association (AMA). CPT codes are also referred to as Level I codes. The HCPCS (pronounced "hik picks") Level II manual contains codes for Transportation Services, Medical and Surgical Supply codes, Durable Medical Equipment, Drugs Administered Other Than Oral Method, Temporary and other codes identifying services and supplies. For diagnosis coding, locate main term(s) and subterm(s) using ICD-10-CM Volume 2 (Alphabetic Index) and verify the code(s) in ICD-10-CM Volume 1 (Tabular List).
Medical Coding is used for ?
Validating necessity of services based on diagnosis for insurance claims, Administrative decisions, Researching the quality of health care, Planning for future health care needs.
Ideal Qualities of the Medical Coder ?
Knowledge of Medical Terminology, Knowledge of Anatomy & Physiology, Critical thinking, attention to detail, Willingness to learn, Accuracy, Self-motivated , Flexibility, Basic computer skills, Organizational skills, Medical coders work in inpatient and outpatient hospital facilities, clinics, physicians offices and insurance companies. Medical coders are also referred to as medical record coders, coders/abstractors, health information coders or coding specialists.
Important Points for Medical Coders and Billers to Remember ?
If it is not documented, it was not done. Do not attempt to code something that is not adequately documented by the provider. Don't guess the codes; always refer to the manuals and then assign the codes. Always use the current editions of the coding manuals for correct and accurate medical coding and billing. October 1st every year: New ICD-10-CM (for Diagnosis and Inpatient Procedures) manual should be used. January 1st every year: New CPT (for Procedures) manual and HCPCS Level II (for Drugs and Supplies) manual should be used.
ALWAYS maintain the privacy and security of medical records (Protected Health Information). [You can use old editions of the coding manuals for training, but for the CPC/CCS certification exam, you need to use the current edition of the manuals.