Each time patients are treated in a clinical setting, their care is coded. This job frequently falls to medical billing and coding specialists. Medical coding records data within the health sector, and the task is a vital part of ensuring functionality of the health care system.
Medical coding can help health care institutions plan their services to better care for patients and allow medical researchers to study the progression of disease. Proper medical coding ensures that the correct amounts are billed to the patient and paid to the medical professional.
Errors in medical coding can cause distress for patients and an inability to balance accounts payable and receivable. Medical coding can help medical professionals identify trends in treatment, disease, and health care across different geographies and demographics.
With the help of artificial intelligence (AI), medical professionals can also predict the future of health care. Medical coding is vital to the health sector, and medical billing and coding specialists play a big role in the accuracy of the coding.
What Is Medical Coding?
Coding is the numeric interpretation of verbal descriptions by medical professionals about patients. Numeric or alphanumeric codes are assigned to clinical procedures, diseases, disorders, and conditions.
A clinical code can be part of a classification system that groups similar diseases and procedures together, helping to organize related medical information. The classification system used in the U.S. is the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).
The official version of the ICD-10-CM guidelines are approved by the Cooperating Parties for the ICD-10-CM, including members from the American Hospital Association (AMA), the American Health Information Management Association (AHIMA), Centers for Medicare and Medicaid Services (CMS), and the National Center for Health Statistics (NCHS).
Planning Services and Studying the Progression of Disease
One of the best known roles of medical coding is to supply data to the health care system. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes are an internationally recognized system that enables accurate descriptions of symptoms, diseases, surgical procedures, and more.
When a medical billing and coding specialist enters information into a medical database, it enables medical analysts to see disease patterns, count readmissions, discover growing trends, and more. This information is vital for planning services and for studying the progression of disease.
Balancing Accounts Payable and Receivable
Medical billing and coding specialists are a mechanism for demonstrating what has happened to a patient as they record procedures, treatments, conditions, disorders, and diseases. A doctor’s office or hospital must code accurately so it can receive payment from clients and purchasing authorities.
If treatment has been coded incorrectly, it can result in missed payments, overcharges, or loss of income to the organization. If someone has a chronic condition classified as a PMB (Prescribed Minimum Benefits), he/she needs to have records coded accurately to ensure that finances come from the most appropriate account and are reimbursed promptly.
The only way these conditions and the linked financial arrangements can be identified is through the medical coding system.
It is vital for a medical billing and coding specialist to code correctly, as errors can cause distress to patients with unpaid bills.
Identifying Health Care Trends
One of the interesting things that can be achieved through accurate medical coding is the identification of variations in the health sector. For example, if an analyst wants to see which areas of the country have the most elective caesarean operations per head of population, the medical professional can use ICD coded data to review which hospitals have high volume.
It is also possible to see length of stay and other indicators to further understand the trends within the health sector. Reviewing coded data can identify hospitals that are doing more or less procedures, which informs variation statistics and trends. Costs of a service can also be benchmarked using coded data, and this can stabilize the price of treatments.
Predicting Health Care Trends
One of the more exciting developments in health care is artificial intelligence (AI). This uses data from patient records that has been coded and analyzes trends to predict behaviors and risk of being admitted to a hospital.
By using technology to identify trends with conditions such as asthma and diabetes, messages can be sent to a clinician or patient with advice on how to prevent relapses or admission to the hospital. This is a developing area, but an exciting one, that is made possible by accurate clinical coding.
Medical coding is a vital part of health care administration and is responsible for accurate billing, as well as predicting trends. It is essential to ensure that staff members undertaking this task receive quality training to equip them with the skills to do the job correctly.
How Records and Claims Are Coded
There are three different types of medical coding that the medical billing and coding specialist will use in day-to-day tasks. They include ICD-10, CPT, and HCPCS.
ICD-10 Coding – The use of ICD-10 helps standardize medical coding internationally. The International Classification of Diseases (ICD) is used to record diagnoses by medical professionals.
ICD consists of numeric and alphanumeric codes that follow an international standard, making sure that diagnoses are interpreted the same way by every medical professional who treats patients around the world.
CPT Coding – Current Procedural Terminology (CPT) coding is a U.S. standard for coding medical procedures maintained by the American Medical Association (AMA). CPT identifies the services provided and helps determine how much medical offices will be paid for their services through insurance company claims.
HCPCS – Healthcare Common Procedure Coding System (HCPCS) is a set of health care procedure codes based on the AMA’s CPT system. HCPCS is a medical billing process used by the Centers for Medicare and Medicaid Services (CMS).
This HCPCS coding system was created to standardize the coding of specific items and services provided by health care professionals and billed to Medicare and Medicaid. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) made the use of HCPCS coding mandatory for processing insurance claims through Medicare and Medicaid.
Interested in learning more about how vital medical coding can help medical professionals and medical researchers find trends to help improve health care? Are you ready for a rewarding career as a medical billing and coding specialist?
The Medical Billing Specialist program at Hunter Business School on Long Island prepares billing and coding students to obtain entry-level employment specializing in medically related billing and coding in physicians’ offices, clinics, medical insurance companies, and hospitals. The Medical Billing Specialist program also offers students a diploma in three months of evening classes.