How does medical coding work?By David Berky
CIO, Find A Code, LLC
If you have ever been to the doctor, then you may have seen the sheet with all of the codes on it for your visit. The doctor circles a few things and gives you the paper to hand to the check out person. The check out person takes the paper and puts it in a stack of other coded visits. You leave only to wonder how they get all the charges straight for your insurance bill. Medical coding is the process that doctor's use to identify the type of service that you receive and the charges for each part of the visit.
An Understanding of Medical Coding
Medical coding is the process of showing what kinds of services were given during any type of doctor visit. It really is an important step in the billing process. A medical coder will read the codes and enter them into a system that will appropriate a bill to the patient or the insurance company. A medical coder and billing agent works very close together to ensure that the billing process is taken care of properly the first time.
Medical Coding at Work
When a service is performed in a doctor's office each procedure has a certain code that has been assigned to it. These codes are used by an insurance company to know what services were provided. The paying company will know what the doctor performed and then they can pay the doctor for the services that were rendered. Once the patient has turned the examination sheet over to the front office staff the codes are entered into a computer and from there the insurance company will know what they have to pay. Medical coding has to be done correctly or the doctor can face steep fines for improper coding.
How the Process Works
In order for medical coding and billing to be accurate the coding and billing staff should have a good understanding of how coding works. They must have the correct information from the doctor's office in order to get the bill correct. To better understand how the process works here is a picture of the process from start to finish.
- When you walk in the front door of a doctor's office and come to the counter the billing process begins. You will be asked your name and what doctor you are seeing. An insurance card and social security number will have to be presented in order to send the charges to the correct insurance company. All the information is checked to verify that the doctor is part of the insurance company's network of providers.
- Once all the information has been gathered from the patient all insurance is verified and sent directly to the doctor's office. If an important procedure is going to be performed, there might have to be some preauthorization before it can be performed.
- After authorization has been approved you can now see the doctor. During your visit your doctor will code the visit so it can be entered for proper billing.
- After the coding has been done the sheet is sent over to an auditor before it is given to the insurance company. The audit team will make sure that there are no errors so the billing can be done correctly.
- The insurance company will pay their part and the patient will have to pay their part based on their own medical insurance policy terms.
Medical coding is an important part of the process of seeing the doctor. It gives non-medical professionals the ability to understand the procedures that a doctor performs on behalf of the patient. It keeps the billing straight and allows for the insurance company to pay the doctor in a timely basis.
David Berky is CIO of Find A Code, LLC. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.
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