How the Internet is Reshaping Medical Coding and BillingBy David Berky
CIO, Find A Code, LLC
Since the Internet is affecting (usually for better) every industry, why should it come as a surprise that medical coding and billing is now heavily dependent on the Internet? Actually, a number of important challenges and changes in the healthcare industry, and in technology as a whole, are pushing medical coders and billers against a wall. The internet, as it turns out, may be just what the doctor ordered in terms of a practical, long-term solution.
There is a move, for example, to go from paper to electronic medical records. Printed material, for one thing, is getting more expensive to produce, thus prompting the use of electronic documents and mobile electronic devices (i.e., digital pads, smart phones, etc.). Most importantly, the ICD-9-CM (International Classification of Diseases) will soon be replaced by the substantially different and larger ICD-10-CM/PCS.
As a general rule, medical coders and billers have had to utilize, on a daily basis, several cumbersome, heavy coding volumes in order to do their job. Needless to say, this has been expensive and inefficient, considering the huge number of codes (different for each code book) coders are forced to use and the fact that the codes keep changing and increasing in number.
When ICD-10-CM replaces ICD-9-CM, the codes will increase from 17,000 to possibly as high as 155,000 and will include extensive revisions including:
- Codes will be more specific and will cover new diseases and procedures.
- The new system will bring about more efficient payment for services provided.
- Medical outcomes/processes should be easier to evaluate.
- More detailed records will be created.
- Codes will go from numeric (usually 5 digits) to alphanumeric (7 characters).
- Coders/billers will also have to start complying with HIPAA 5010 (related to electronic records).
Due to these extensive changes to the code sets used to report diagnoses, coders and billers will need better coding tools made available to assist in the code selection process. Coding search organizations and software tool builders will be creating programs that will aid the medical coder and biller in performing their tasks.
One such organization, FindACode.com, for example, has created a number of very useful tools that can help coders/billers perform their jobs more efficiently. Some of the tools available to coders through FindACode.com include:
- Extensive and detailed search
- Index text and search capability
- Detailed code descriptions and layman descriptions
- Code building
- Code list building
- Additional personalization tools like code-specific notes and fee schedules
- Industry-leading validation tools
- Fee schedules
- NCCI validation and more
In addition to conducting real-time, as-needed, on-the-move (if necessary), code searches (faster and much more conveniently than through the use of code books), the average online medical coding tool includes benefits such as the following:
1. Medical terminology (anatomy and physiology) refreshers, tutorials and lookups.
2. Electronic versions of most popular coding texts:
a) Current Procedural Terminology (CPT) b) Healthcare Common Procedure Coding System (HCPSC) c) International Classification of Diseases (ICD), etc.
3. Governmental guidelines on how to best comply with the Health Insurance Portability and Accountability Act (HIPAA), especially in reference to version 5010.
4. Opportunity to download or purchase new software that can help coders do their job better or more easily.
5. Guidance in how to best comply with Medicare provisions and specifications.
6. Opportunity to renew or seek new certification in order to comply with legal and employer requirements.
7. Staying in touch with the latest news in the industry through special newsletters, blogs, professional discussion forums, and conferences.
8. Opportunity to be informed of most current code changes.
9. Receiving “coding alerts” that can prevent payment problems and billing denials.
10. Chance to use industry trademarked systems like Build-A-Code, Click-A-Dex, and NCCI Edit Validator.
11. Staying in touch with sensitive, constantly-changing malpractice issues, procedures and guidelines.
12. Staying abreast of the latest demands in such special categories as: a) Diagnosis Related Groups (DRGs) b) Ambulatory Payment Classifications (APCs) c) Provider Taxonomy Codes
Notwithstanding all the benefits that can be derived from the average online medical coding tool, the fact remains that medical coding and billing as a profession has some great challenges ahead of it. Not only will new healthcare laws change the playing field, but the massive changes that American society is undergoing will also bring about tremendous challenges.
Will the government, for example, be able to continue to properly fund Medicare? How will the growing number of uninsured Americans affect the healthcare industry? What about fraudulent healthcare claims—how will this affect the medical coding/billing profession? How will the new Healthcare Reform Law play out in the future or will it be repealed?
After all, over five billion claims for payment are processed in the US each year. This massive amount of paperwork demands a medical coding workforce that is not only conscientious but competent and well-prepared for the many changes coming.
To that end, you, the professional coder and biller, need to avail yourself of all the tools available (especially online) in order to maximize your efforts. By doing the best possible job, you can help society keep healthcare costs low, prevent costly foul-ups, help reduce fraud, and make sure patients get well-orchestrated, fair, and cost-effective medical care.
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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