Why You Need Medical Coding


Medical coding has been around as a profession in the healthcare insurance sector for a while now. Let us get down to understanding medical coding then. Medical coding is a practice in which the full set of medical data relating to a patient, which could range from diagnosis to medication, is converted into set codes for the insurance companies to take further. Why is it necessary to convert these data into codes? Medical reports are usually very lengthy and detailed in nature. They are written in very highly medical jargon, as well. If the entire history of an admission were to be described, it would run into pages sometimes. The medical history is usually not only detailed, but also many times diffuse in that it describes all the symptoms, the history, the allergies, the medications and several other details. Why you need medical coding is best understood if one takes a look at what would happen without it: If insurance providers receive this form of reports about a patient, they will have to spend all their resources and time in just understanding the reports. When one considers the fact that there are close to one-and-a-half billion visits to doctors across the nation in a year, one can understand why medical coding is crucial. Imagine the size of the problem if insurance companies were to handle just a handful of details per case. Helping to classify diseases Having codes for each ailment helps the insurance companies to quickly understand the nature of the illness and the treatment given. This will help them process the steps necessary for the claims. This is why internationally standardized codes are made available for helping the healthcare sector as well as the insurance companies streamline the humungous documentation that goes into medical coding. This is the primary reason why you need medical coding. The coder is thus required to have a clear grasp of the conditions, diagnoses, the doctor’s interpretations of the symptoms, the nature of the disease to an extent and of course, the ins and outs of coding and how these fit into coding and billing. This calls for extreme attention to detail, which is why you need medical coding. At present, medical coders need to have knowledge of three internationally accepted code systems: International Classification of Diseases (ICD) The ICD was set up by the World Health Organization in the 1940’s to set a uniform terminology for the causes of illnesses, injuries and deaths. From the time of its inception, it has undergone many changes, with each updated version being represented by a new number. The current ICD version is the tenth one, which is why the code now in use is called ICD 10. It has what is called Clinical Modification, with expands the list of diseases and helps coders a little more in their interpretation. The Clinical Modification for the current ICD 10 code enlarges the scope of codes by almost five times. Current Procedure Terminology (CPT) CPT is used to code medical procedures carried out in a physician’s’ practice. CPT consists of three categories that are spelt out in five-digit codes. Healthcare Common Procedure Coding System (HCPCS) The HCPCS codes are those that the CPT does not cover. These typically include items such as ambulance rides, prosthetics, durable medical equipment, and some types of medicines and drugs. Another fact about the HCPCS is that it is the official code set for a variety of services such as Medicaid, Medicare, drugs given for chemotherapy, care given to outpatients at hospitals, and others. It being the code for Medicaid and Medicare makes it one of the primary codes in use. Given the complexity of the nature of coding and the innumerable uses they serve, it is not difficult to grasp why you need medical coding in the healthcare sector.

Date Posted: 06 Nov 2018