The Guide To Medical Coding For New Healthcare Practices

Medical coding is the translation of healthcare information that may concern a patient’s condition, diagnosis, prescriptions, and accompanying procedures. These, in addition to medical equipment and services, are converted into universal medical codes, which are essential components of medical claims.

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Understanding medical coding

Understanding medical coding

Medical coding is the translation of healthcare information that may concern a patient’s condition, diagnosis, prescriptions, and any accompanying procedures. These, in addition to medical equipment and services, are converted into universal medical codes, which are essential components of medical claims. These codes are taken from virtually any medical record, such as laboratory results, medical examinations, and physician notes. While only 100,000 medical coders work in the US, it has become a highly sought-after skill to employ within medical healthcare practices. Medical coding ensures that the next medical billing is accurate and assures that insurance carriers pay the appropriate claims. 

While it sounds complicated, many companies, such as Carepatron, provide resources for medical coding for new healthcare businesses to guide you about medical coding. This can significantly alleviate any concerns you may have about ensuring the correct codes are used and in the proper format. Regardless, we have compiled this guide for you to better understand and navigate the area of medical coding in hopes of developing greater confidence in its use.

Why is medical coding necessary?

Not only are medical coding services helpful, but quite simply, they are an absolute necessity to medical healthcare practices. Medical coding is very closely linked to the process of medical billing, as they determine their accuracy and amount. 

For healthcare businesses to get paid, they have to submit claims to the insurance providers of patients. Claims comprise healthcare provider information supplied in inpatient notes, which generates specific charges by specific codes. The codes correspond to treatments that the patient received, as well as any other medical records. These medical codes are vital as they come from international guidelines, such as the following examples:

  • International Statistical Classification of Diseases and Related Health Problems (ICD-10)
  • Current Procedural Terminology (CPT)
  • Healthcare Common Procedure Coding Systems (HCPCS)

These sources each refer to different areas of medical coding, including the classification of diseases and illnesses, medical services and procedures, and other systems not within specific coding guidelines.

Medical coding is essential to create a universal medical record that healthcare professionals and healthcare insurers can understand. Because they are translated into medical health claims, it is vital to ensure that the information is accurate, and coding allows for this high degree of preciseness.

Why is medical coding necessary?
Who is responsible for coding at a medical office?

Who is responsible for coding at a medical office?

So, to implement medical record coding practices, do you need medical coders? 

Well, the answer to that is yes and no. 

Ideally, you do, but medical coding is a responsibility that various roles within medical offices undertake. It is interlinked with the billing process, so multiple clinical and office functions are relevant for this process. 

  • Office staff - Staff, dealing with appointment scheduling, patient registration, verification, and insurance eligibility are essential in the medical billing and coding process. Supplying up-to-date information concerning patients, as well as authenticating information, are both critical for submitting medical claims. 
  • Healthcare provider - Notes provided by doctors and nurses are then used for translation in the medical coding process. Interpreting the notes well means that claims are more likely to be accepted without further amendment or submission. 
  • Medical coder - The medical coders are the core component of the coding process, as they interpret clinical notes provided by healthcare professionals to identify specific charges. Once selected, they then assign the appropriate code to be used for billing. 
  • Medical billing specialist - As the last step, medical billers will check to make sure claims are compliant with relevant policies, laws, and standards. Once finished reviewing, they submit the claim to a clearinghouse for further cleaning. Medical billers can also chase up unpaid claims, as well as follow up on any denied claims.

What are the primary medical coding systems?

When it comes to medical coding systems, there are various ones you can use that are designed for different purposes. While many healthcare businesses are beginning to outsource medical coding services, and with medical coding also becoming automated, it is still essential to understand their uses. 

  • Current Procedural Terminology (CBT) outlines the types of medical services healthcare providers provide to their patients. Examples include surgeries, evaluations, examinations, and any tests. These codes will be submitted to medical insurers for reimbursement, and patients can double-check the pricing information if they wish.
  • Healthcare Common Procedure Coding System (HCPCS) - There are two levels to these codes, with level I used to identify medical services and procedures used by physicians or other licensed professionals. This level is mainly based on CPT codes. Level II identifies non-licensed professional services, such as wheelchairs, ambulances, and other medical equipment. 
  • International Classification of Diseases (ICD) is the international standard system for reporting diseases and illnesses. Developed by the World Health Organisation (WHO), they may use death certificates and hospital records to count deaths and diseases. Currently, the ICD-10 system is in place. 
  • International Classification of Functioning, Disability, and Health (ICF) - This is very similar to ICD; however, it looks at health and disability regarding a health condition. ICF involves looking at function and how a person operates concerning their environment. 
  • Diagnostic-related group (DRG) refers to categorized medical codes based on types of treatment, diagnosis, and other criteria. As a result, hospitals and clinics are charged a fixed rate for inpatient services depending on the DRG assigned to the patient. The DRG selected states that the patient will slot into the specified profile and needs the same care and services. 
  • National Drug Code (NDC) - The NDC applies to medication and identifies the product labeler, product, and package size and type of medications. The code is ten digits and is present on all prescription and non-prescription medicines.
  • Code on Dental Procedures and Nomenclature (CDT) - This code relates to oral health and dental services
  • Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) concerns psychological and psychiatric illnesses. While the 5th edition of the DSM was produced in 2013, ICD-10 codes are recommended to refer to these conditions. 

Final thoughts: Automating medical coding with Carepatron

Medical coding is an essential component of healthcare businesses in submitting claims for billing purposes appropriately. It allows for a universal format that can be understood by healthcare professionals all over the world to ensure continuity and consistency of billing processes. 

While there are a variety of coding systems to use, sometimes this can feel overwhelming. Healthcare business platforms, such as Carepatron, improve your clinical documentation by implementing medical coding and billing software that elevate your service quality. With a user-friendly interface, Carepatron provides the opportunity for you to learn more about medical coding and billing and master the learning curve with its automated processes. 

Don’t let the abundance of medical coding burden you. Medical coding can be an exciting process to ensure your patients receive the highest level of care, and so spend some time evaluating your options. 

Further reading:

What are the primary medical coding systems?

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