Medical Coding

Medical Coding

Medical coding is the translation of medical reports into a shortcode used within the healthcare industry. This helps summarise otherwise cumbersome medical reports into efficient, data-friendly codes

Medical coders are individuals responsible for translating physicians’ reports into useful medical codes. These professionals work behind the scenes in a variety of settings, ensuring all pertinent information is coded appropriately to ensure consistency and accuracy.

After a medical provider examines or treats a patient, the insurance company needs to understand what was done in order to process the bill. Common language is inexact to give the insurance company the accurate details it needs, so a set of specific codes has been established to define medical procedures. It is the role of a medical coder to provide this information in a way that is useful and efficient.

While complex and detail-driven, medical coding really comes down to knowing how to navigate the three main code sets: CPT (Current Procedure Terminology), ICD (International Classification of Diseases), and HCPCS (Health Care Procedural Coding System). These code sets help coders to document the condition of a patient and describe the medical procedure performed on that patient in response to their condition.

Scope and growth for medical coding amid pandemic

The rise of the pandemic in 2020 let the healthcare industry take the centre stage globally bringing for the challenges both hidden and visible that needed immediate attention. As healthcare providers have been stretched to deal with the burgeoning problem at hand, there is a heightened demand for labour across departments, thus boosting healthcare offshoring across countries.

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In India, the healthcare offshoring industry has witnessed business growth. India is known to be the second-largest healthcare outsourcing destination. Nearly 80 per cent of healthcare business from USA is outsourced to India. Thus, the demand for professional medical coders is increasing and they play a crucial role in the healthcare delivery system.

The need and demand for medical coding will only keep rising since the recent advance of computer-assisted coding (CAC) has only helped ease the job of medical coders the world over.

To pursue medical coding, an individual must have a bachelor’s or master’s degree preferably from a life sciences background. One must have the analytical ability to read and analyse medical records and patients details by using the right codes for billing procedures

The Medical Coder and biller process a variety of services and claims on a daily basis. Medical codes must tell the whole story of the patient’s encounter with the physician and must be as specific as possible in capturing reimbursement for rendered services. To better understand what a coding transaction looks like, read the article “What Does a Medical Coder Do?”

The main task of a Medical Coder is to review clinical statements and assign standard codes using CPT®, ICD-10-CM, and HCPCS Level II classification systems. Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The Medical Coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To help promote a smooth coding and billing process, the coder checks the patient’s medical record (i.e., the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies, and other sources) to verify the work that was done. Both work together to avoid insurance payment denials.

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.

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