Medical coding refers to the transformation of healthcare diagnostic procedures, medical services, and instruments into alphanumeric universal codes for medical use. The codes for diagnoses and procedures are derived from medical records documentation, including transcriptions of physician notes, radiologic and laboratory results, and more.
Medical coding professionals ensure that the codes are used correctly throughout the medical billing process, which involves abstracting information from the documentation, assigning proper codes, and then submitting claims to be reimbursed by insurance companies.
Medical Coding occurs each time you visit a healthcare professional. The doctor examines the medical history of your complaint, makes a professional diagnosis of what’s wrong and the best method to treat you, and records the visit. The documentation doesn’t only serve as a record of a patient’s life; it’s also how the healthcare professional is paid.
Hospitalist coding plays a crucial role in ensuring accurate billing and reimbursement for inpatient medical services. Since hospitalists primarily manage patient care within hospital settings, proper documentation and coding are essential for capturing the complexity of their services.
Medical coders translate medical documentation into standard codes that tell payers what they need to know:
- Patient’s diagnosis
- Medical necessity for medical treatments, services, or products the patient received
- Treatments or services and/or supplies offered to the patient
- Unusual circumstances or medical conditions could have affected this treatment and services.
Medical coding is a distinct discipline. Medical coders are regarded as part of the medical care team, typically working closely with healthcare management, providers, and payers. A scholar, detective educators, and problem-solver Medical coders have specialized abilities.
Medical coders and billers deal with a wide range of claims and services every day. Medical codes should be able to give a complete account of the patient’s experience with their physician and be as precise as possible to get reimbursement for the services. To get a better understanding of how a coded transaction appears, check out the article: What do medical coders do?
The primary function of medical coders is to examine clinical reports and determine a standard code based on CPT(r), ICD-10-CM, CPT(r), and the HCPCS level II system of classification. Medical billers, on the other hand, manage and monitor requests by health insurers to ensure reimbursement of services provided by a healthcare professional.
What is the reason medical codes are needed?
The revenue stream from healthcare can be attributed to the record of the information learned, interpreted, and acted upon.
A patient’s diagnosis, test results, and treatment must be documented for reimbursement and to ensure top-quality care for subsequent appointments. The patient’s health information will be with them throughout any subsequent issues and treatments, and they must be able to comprehend it. This is particularly important when considering the countless millions of procedures, visits, and hospitalizations annually across the United States.
The problem is the number of diseases, conditions, or injuries that can cause death. Also, thousands of procedures that health professionals provide and a similar quantity of injectable medicines and medical supplies are to be tracked. Medical Coding categorizes these services to make it easier to report and track.
In healthcare, many descriptions, acronyms, names, and eponyms are used for each process, disease, and tool. Medical Coding standardizes the presentation and language of these elements so that they are easier to recognize, track, and change.
