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Medical Coding

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WHAT IS MEDICAL CODING?

Medical coding takes the descriptions of diagnoses, injuries, diseases, and other healthcare procedures performed from physicians and transforms them into a numeric or alphanumeric code format. In simpler terms, medical coding is a process of translation. A medical coder will take a clinical statement such as a doctor’s diagnosis or a prescription for a medication, and will translate this into a particular code. Every type of injury, diagnosis, and medical procedure will have a corresponding code. Every code will also have its own set of guidelines. For instance, a code pertaining to a pre-existing condition will need to be placed in a highly specific order. Accurate coding within these set rules and guidelines will have an impact on the status of a claim.

Medical coding begins with a patient encounter in a hospital or physician’s office. The provider will detail the visit through the patient’s medical record and will explain why a specific service or procedure was performed. The process ends when the medical provider enters the appropriate codes into a software program. Once coded, it is passed on to the medical biller.

WHY IS MEDICAL CODING IMPORTANT?

Closely tied to the process of medical billing, medical coding is a crucial aspect of the healthcare system. When performed accurately, the process not only promotes patient safety and efficient operations but also ensures that hospitals and other care delivery organizations are properly reimbursed for the services they provide. In addition to assisting the medical billing process and helping expedite the payments for physicians, medical coding also serves as a tool for comparing projects, identifying under-served healthcare areas, and making the necessary plans to improve them. Medical codes also aid in administrative functions and help identify symptoms that must be referenced and addressed by other physicians. In summary, medical coding can help providers and their staff operate a smooth revenue cycle and claim all reimbursements that would allow for the consistent delivery of quality patient care.

CODING CHANGES

WHAT YOU NEED TO KNOW

There is a new International Statistical Classification of Disease (ICD-10) which replaced ICD-9 on October 1, 2015. This change amends the recording of the coding needs in medical billing by adding more classifications, but this update requires some getting used to and may require necessary steps by coding experts in order to have their medical insurance claims filed and processed. Physician Revenue Solutions offers an easy-to-use code conversion tool to assist with this transition on our website. It will allow you to easily convert ICD-9 codes to the most updated corresponding ICD-10 codes.

HOW CAN THIS AFFECT YOUR PRACTICE?

As described by the AAPC, the ICD-10-CM is a standardized classification system of diagnosis codes that represent conditions and diseases, related health problems, abnormal findings, signs and symptoms, injuries, external causes of injuries and diseases, and social circumstances. Since ICD-10 coding involves a high level of specificity, coders will need to develop familiarity with medical terminology, human anatomy and physiology, pharmacology, disease processes, diagnostic methods, and treatment.

The information gathered from these codes will aid in the improvement of healthcare performance and allow for the proper processing of claims. Fortunately, the right tools are easily accessible for you to be able to submit claims with the proper codes in place.

WHAT YOU SHOULD DO:

There are available online webinars you can review to gather the information needed to see how ICD-9 translates to ICD-10. Once you review these webinars, you will see the new complexities that are in place regarding ICD-10 which thankfully, are easily converted to make your billing process a seamless one.

Our certified professional coders continue to provide ongoing training programs to ensure you can easily transition from one coding matrix to the next. We have upgraded our IT infrastructure to meet the new ICD-10 and HIPAA compliance regulations. Our team continues to develop new conversion tools which can help you process claims easier.

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