You hear a loud pop in your left arm, followed by intense pain. You visit the doctor and sure enough, it's broken. As the doctor examines you, he or she will most likely be sitting at a computer during your visit typing notes, or writing down on a clipboard documenting what has happened to your arm. Once the visit is over, the doctor needs to get paid by the insurance company. This is where medical coding comes in. The doctor cannot simply send over the notes from your encounter. The insurance company requires a medical code. A medical code in this situation would look something like this:
There could be a handful of similar codes that help document the visit to your doctor.
Therefore, medical coding is the translation of medical reports into a short code used within the healthcare industry. This helps summarize otherwise cumbersome medical reports into efficient, data-friendly codes. While complex and detail-driven, coding really comes down to knowing how to navigate the three main code sets: CPT, ICD, and HCPCS. These code sets help coders document the condition of a patient and describe the medical procedure performed on that patient in response to their condition.
The entire world depends on medical coding as defined by WHO (World Health Organization). We use it to better understand the overall health and wellness of people around the world. In the US we also use it to help providers get reimbursed for their services by medicare and other insurance companies. Where did it start, and how did it come to be?
Origins can be traced back to John Gaunt a physician from London who lived in the 1600's. He developed a system to document what was happening to his patients to better understand the mortality rate in England. The study became known as "The London Bills of Mortality". Initially the bills of mortality was to determine the reason children under 6 years old were dying.
Medical coding can be full of unknown terminology and TLA's (three letter acronyms). It can be daunting and often times overwhelming to have a slew of words coming at you that might sound like Mandarin to an unfamiliar ear. Our staff’s experience combined would probably equal centuries of medical coding knowledge, yet at times we will still hear a word that we are not familiar with. We thought it would be useful for industry peers to create this resource full of medical coding vocabulary and key terms. Without further ado let’s get started:
This designation, created by the National Center for Health Statistics, is added to the ICD code sets when they are implemented in the United States. The ICD-10 code set went from 14,000 codes to over 68,000+ codes with the transition to ICD-10-CM. The term "CM" added to the end stands for "clinical modification".
The concept is quite simple: Determine what is wrong with the patient, and then document what you do about it. As simple as it may seem, providers all across America struggle with this highly impactful piece of the business. Revenue and regulatory compliance are two of the most discussed topics of impact. While those two factors are of the upmost importance submitting clean claims remains one of the most important parts of any providers clinic.
Where do you start whether you are a physician, administrator, or an integral part within the revenue cycle? Below are three very important points to consider: