What is Medical Coding?

History and Pertinent Facts

Coding was devised to help standardize billing to insurance companies as well as to provide more information about diagnoses, treatments and the epidemiology of disease.

  • CPT codes:  The Relative Value System (RVS) was designed by insurance companies.  It was used for many years, and then evolved into the Current Procedural Terminology (CPT) and was copyrighted by the AMA. The CPT tells what the physician did to correct the problem.
  •  ICD Codes:  The International Classification of Diseases (ICD in various versions, currently the 9th revision) reports various diseases.  The ICD tells what is wrong with a patient and shows medical necessity.
  • HCPC Codes:  A third system was developed by HCFA (Healthcare Financing Administration)  in 1982 for Medicare and Medicaid billing.  They contain CPT, National, and Local codes.  CPT codes are considered to be the level 1 codes of HCPCS.  National codes are the Level 2 codes of HCPCS.  Local codes are level 3 codes of HCPCS.  Used for billing procedures and services that include dental work, durable medical equipment, injections, ophthalmologic services, orthotics, some laboratory and pathology, and vision care.
  • APC Codes (Ambulatory Patient Care) are used by hospital outpatient departments.

So What Do Coders Do?

They look up various diseases and treatments using an alphabetic system which points them to specific detail relating to patient problems and the medical care to fix the problem.  They use CPT, ICD, and if working in a hospital or large clinic, they use APC codes to cover items not in the CPT and ICD code systems.

E-Codes:  If the patient is involved in an injury of some type, the E-Codes are used to explain how and where the injury happened.  They even cover adverse reacftions to drugs or other products.  The E-codes are found in the ICD-9 book.

V-Codes:  These codes are used to describe health maintenance when no disease is present, e.g., physical examinations, vaccinations, injections, etc.  They are also found ion the ICD-9 book.

Volume III ICD 9 Codes:  These codes are used by hospitals, clinics, surgical centers, and relate to room charges, supplies, durable equipment, etc.

The Future for Coders:

Dramatic changes are expected with the full adoption of the ICD-10 protocol.  Although its impact will be significant, ICD-10 is far from the only healthcare initiative that will ultimately change what it means to be a professional coder. The move to the expanded code set is just one of several forces driving that change, joining accelerated EHR adoption, healthcare reform, and expanded use of computer-assisted coding (CAC) as the principal movers and shakers.

Advances in technology and increased regulatory compliance are creating a new emphasis on both the speed and the accuracy of coding, in particular, as electronic records sharing expands to encompass healthcare facilities across the nation.

Historically, reimbursement is the primary driver for coding today, patient care, data management, and data integrity will be additional drivers 10 years from now.  Access to patient medical data will be crucial for comparisons of effective and cost-efficient approaches to patient care. The end goal is to provide better patient care at a much lower cost while utilizing a more preventive approach. In order to achieve that goal, national and international data must be accessible and analyzed effectively. The required data points on a record will continue to evolve, and the complexity will require a more analytical, technically oriented coder.

An early result of the EMR and the related information was the basis for the  (CMS) decision to no longer pay for hospital-acquired conditions.

These changes promise to reshape HIM (Health Information Management) and, in particular, coding.

The capacity for electronic transmission has finally progressed enough so that the grand vision to collect clinical data and use it in very sophisticated ways can actually be done.

A Shift in Focus
Perhaps one of the biggest changes to the profession in the coming decade will be the transformation of coders into auditors, a development being driven in large part by the technical advances that are automating significant portions of the documentation and coding process.

With advances in technology, the coder role will be more of a coding reviewer or auditor, with most of the actual coding performed by either EMRs or CAC. Coding will be required more on an exception or completion basis rather than today’s comprehensive requirements.  That doesn’t mean the job will be any easier, though. The skill sets required will be more  analytical, with an understanding of billing, clinical documentation, and utilization in addition to coding.

Here at med-certification.com, coders have a very interesting career path to follow.  It’s a great time to be learning how to do it!  Review the training page or call for more information 888-771-1902.   Coding Training:   ICD-9 AND 10 CODING TRAINING COURSE

Medical Coding Course