Medical CodingJuly 30, 2021 2021-09-22 22:11
What is Medical Coding?
Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc. Medical coding professionals help ensure the codes are applied correctly during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers.
Medical coding happens every time you see a healthcare provider. The healthcare provider reviews your complaint and medical history, makes an expert assessment of what’s wrong and how to treat you, and documents your visit. That documentation is not only the patient’s ongoing record, it’s how the healthcare provider gets paid.
Medical codes translate that documentation into standardized codes that tell payers the following:
- Patient’s diagnosis
- Medical necessity for treatments, services, or supplies the patient received
- Treatments, services, and supplies provided to the patient
- Any unusual circumstances or medical conditions that affected those treatments and services
Like a musician who interprets the written music and uses their instrument to produce what’s intended, Medical Coding requires the ability to understand anatomy, physiology, and details of the services, and the rules and regulations of the payers to succeed.
Medical coding derives from public bills of mortality posted in London in the 18th century. It was through correlating these that doctors determined the cause of a cholera epidemic. It is even more vital now as the data gathered through Medical Coding is used to improve healthcare overall. The results are submitted to payers for reimbursement, but the data derived from the codes also are used to determine utilization, manage risk, identify resource use, build actuarial tables, and support public health and actions.
Why is Medical Coding Needed?
The healthcare revenue stream is based on the documentation of what was learned, decided, and performed.
A patient’s diagnosis, test results, and treatment must be documented, not only for reimbursement but to guarantee high-quality care in future visits. A patient’s personal health information follows them through subsequent complaints and treatments, and they must be easily understood. This is especially important considering the hundreds of millions of visits, procedures, and hospitalizations annually in the country.
The challenge, however, is that there are thousands of conditions, diseases, injuries, and causes of death. There are also thousands of services performed by providers and an equal number of injectable drugs and supplies to be tracked. Medical coding classifies these for easier reporting and tracking. And in healthcare, there are multiple descriptions, acronyms, names, and eponyms for each disease, procedure, and tool. Medical coding standardizes the language and presentation of all these elements so they can be more easily understood, tracked, and modified.
This common language, mandated by the Health Information Portability and Accountability Act (HIPAA), allows hospitals, providers, and payers to communicate easily and consistently. Nearly all private health information is kept digitally and rests on the codes being assigned.