Maximizing Medical Coding SkillsBy Aimee Wilcox, MA, CST, CCS-P
In today's ever changing and evolving technological world medical coding professionals face major challenges.
Within the past 20 years, medical coding has evolved in a significant way. In the 80's most documentation handwritten or transcribed; sometimes typed on an electric typewriter. As advances in technology became more affordable to the public in general, personal computers were used to type documents and save them on floppy disks.
Medical coders were a rare commodity as a specific job title but were in general, part of a greater medical assisting training learned through local colleges. Training for these programs were in all aspects of medical office management including: receptionist, transcriptionist, back office medical assistant, medical coding and billing.
Large walls and even rooms filled with file cabinets of patient's medical charts were stored and maintained by medical personnel. These charts contained labs, tests, office notes, hospital notes, and all information pertaining to a patient's care. Filing was done daily into these charts and when a patient was seen, the provider would either hand write the note or dictate it and have a transcriptionist type it up to put into the chart.
Coding was done through the use of a superbill or chargemaster checked off by the physician with surgical services and procedures being coded by coding and billing personnel with the assistance of the medical provider as needed.
Paper was seen everywhere until it became more affordable and feasible to use personal computers to manage information.
The technology boom from the 1980s to the present has brought about enormous changes to how we manage information.
Although there are still some providers who use the paper medical chart, there has been a surge in providers who have progressed to the electronic medical record. Specialized software programs have been designed to meet the specific needs of the medical office and medical facility.
Patients once registered via a new patient information sheet filled out and then attached to the inside of the patient's medical record are now typed into medical coding and billing software programs and stored permanently on the computer.
Coding, which was previously done manually using the large and rather cumbersome ICD-9-CM diagnostic and CPT procedural coding manuals, is now performed via encoding software programs. These programs allow a simple search of specific terms which allow the program to go through a process of elimination to get to the correct code faster and more proficiently.
Once the proper codes were selected and entered into the computer system, dot matrix printers were used to print the HCFA insurance claim form, which was in duplicate form. The original (top page) was mailed to the insurance company and the carbon copy was filed with billing payment receipts, and records for follow-up on insurance payments and accounting.
Now, codes are entered into medical coding/billing software programs and the claims are either submitted via electronic remittance to the insurance company or printed quickly using a laser printer on a single HCFA and mailed to insurance companies that are not yet set up to receive electronic claims.
It has become very easy to resubmit a claim or correct a claim using the software programs we now have versus those from a couple decades ago.
Insurance payments would come in the mail requiring a coding and billing specialist to manually enter the payment information into the computer and send the patient a bill for the balance.
Now, many large and small insurance carriers will direct deposit payments into the provider or facility's bank account and remit the explanation of benefits in electronic format via secured internet networks and even automatically post the payment to the patient's account.
So, as you can see, modern advancements in technology have played a rather large role in changing the way a medical coder and biller perform their jobs. As such, a medical coder and biller can perform their tasks much faster requiring the coder or biller to take on an increase in productivity.
Besides all the high-tech HIPAA laws that have been put into effect to secure patient information from falling into the wrong hands, additional computer system requirements have been put into effect to allow for better transfer and receipt of data between facilities and providers and insurance companies and government agencies the most recent and upcoming major changes to the medical industry is the change from ICD-9-CM diagnostic data set to ICD-10-CM diagnostic data set.
Where medical offices and facilities once were able to determine the pace at which they made technological advances in their office, new federal requirements have made is so that it is difficult and providers and facilities can be penalized for not having these technological advances in use in their practices.
With advances in medicine, technology-assisted diagnostic and surgical equipment and advances in medications, parameters for the treatment of certain diseases and conditions can be managed more precisely. This means that insurance companies, especially Centers for Medicare and Medicaid (CMS) can better determine if a procedure or test is the right thing to do for a patient.
This puts the determination and proof of medical necessity back on the medical provider. Providers and their staff may see what proof of medical necessity is needed for certain procedures to be ordered prior to ordering them.
A common procedure performed for chronic back pain is radio-frequency ablation of a spinal nerve. This is where the doctor places electrodes on a specific spinal nerve or nerves and burns them to destroy them. They don't grow back for approximately a year, providing pain relief to the patient and many times a reduction or complete discontinuance of the need for chronic pain medications.
But, if you were examined by a physician and simply told him you have this chronic back pain that just won't go away and pointed to where it is located and even told him that ibuprofen is not working, this is not enough to this particular procedure to be medically necessary.
Enough data has been gathered from so many medical records for patients who have had this procedure done that it has now been determined that patients with a specific diagnosis of facet joint arthritis or spondylosis experience relief from their chronic back pain symptoms associated with this when they have this specific procedure performed.
It has then been decided that specific criteria must be met with patients complaining of chronic back pain in order to perform this procedure. Some of which includes:
- Documentation via MRI of facet joint arthritis.
- Failure of pain medications to control pain.
- Failure of physical therapy (up to three sessions) having been performed.
- Facet joint block(s) that relieve anywhere from 75-80% of pain.
Once this information has been gathered and documented, the radio-frequency ablative procedure will be considered medically necessary.
Due to technological advancements making data mining and data gathering much easier, we will begin to see more and more procedures that have a requirement for documentation by the provider to prove medical necessity or the claim will not be paid.
This puts a great demand on medical coders to know and understand how to locate this information and disseminate it to their providers. When claims are denied for medical necessity, the medical coder can then return to the provider and show them the information that was not proven. If the provider can show that the proof is present then appeals can be submitted to the insurance company and payment received.
This scenario shows that the ability for medical coders to have immediate access to information is vital to the success of a medical practice and facility. There are many companies that provide educational information to medical coders and medical practices to aid them in the coding and billing process. This information comes in many forms: electronic, CD, individual websites, books, etc.
One company, FindACode.com, has created a fantastic product that provides immediate access to all of this information and in a database that is completely searchable.
It also contains all the upcoming diagnosis codes and crosswalks for ICD-10-CM that will be put into effect in October of 2014.
FindACode.com provides a plethora of information that supports medical coders and billers in their careers. It is customizable, so any facility or medical practice can determine what information they would like to use and pay for; a type of buffet-style service of information. Simply look up FindACode.com and get started making your job easier and more productive today.
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. 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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