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Medical Billing and Coding, ICD-10-CM, ICD-10-PCS, CPT, HCPCS, etc.
Viewing:  Dec 9, 2016

What is Medical Coding?

By David Berky
CIO, Find A Code, LLC

Medical coding is a process that is essential to the medical profession in order that medical diagnosis and procedures are classified properly. Those who pursue a career in medical coding have specialized training in medical terminology and how to research and determine the correct codes for insurance claims based on notes from medical records. Claims for payment are sent to insurance companies and government programs like Medicaid and Medicare. Doctors and practitioners in the health care industry depend on proper medical codding to report diagnosis and treatments for patients.

Medical coding professionals also play a key part in the medical billing processes. Each time professional health care services are rendered by a physician, hospital, outpatient facility or surgery center the provider must document all services that are provided and the rational for those services (diagnosis, test results and findings). The medical coder documents the information by assigning appropriate codes in order to create a bill for those services.

For this process to be initiated properly, the coder uses the patient's medical record to determine the proper medical codes from the doctor's notes, ordered testing, or x-ray imaging. A code must be assigned, called CPT codes, HCPCS codes an d ICD-9 codes to report what diagnosis were determined and what procedures were performed and to provide necessary billing operations.

Diagnosis codes also also use to document and track contagious diseases, are used as numbers and statistics for research and health industry surveys and reports. Coders utilize the CPT/HCPCS code sets to record all procedures, injections, medical supplies and medical devices used in the treatment of patients.

Tools of the Trade

In the past medical coders and billers relied on large books with thousands of pages listing all the medical codes and as much additional information as the publisher could squeeze in. Coders and billers would have one or more books for each code set and often several other books with additional code information. Most coders and billers had a library of books stacked on shelves around their desks. Also the code sets were typically updated each year. So you could find several annual sets of coding books.

As more and more information has become available about the medical codes and how and when to use them, the number and sizes of these coding books continued to increase. It has reached the point where a professional coder needs the assistance of technology to maintain their effectiveness and accuracy.

FindACode.com, http://FindACode.com, is one of a handful of companies that have risen to meet this need for enhanced medical coding and billing technology. FindACode has taken the information from the 100s of coding books and put it all into a searchable database accessed via their website. The coding information is extensively cross-linked, indexed, sourced and updated as often as the code sets are (may of which are now updated quarterly, monthly, even weekly). FindACode offers a subscription service that provides this information to professional coders and billers.

Introducing the ICD-10-CM and ICD-10-PCS Code Sets

Not only do medical coders and billers have to contend with the thousands and thousands of pages of information on the current medical code sets, but beginning in October of 2014, two new code sets will be introduced to professionals that will increase the number of procedure and diagnosis codes by 10 times the amount of codes in the current code sets.

The new ICD-10 code sets will replace the ICD-9-CM diagnosis codes and will include all procedure codes for use within all hospital facilities. However, CPT/HCPCS codes can still be used for many doctor's offices, and outpatients facilities, but Medicare has stated that they will accept procedure codes form either the existing CPT/HCPCS code sets or the new ICD-10-PCS code set. These International Classification of Disease (ICD) codes will follow the patient from diagnosis through treatment phases. The ICD tracking system is the oldest method of tracking mortality and diseases in the world. Each code correctly identifies standard diagnostic classifications for all illnesses.

The changes to the ICD-10 code reporting will encompass the health care industry and the implementation of the ICD-10 PCS, or Procedural Coding System, will be a challenging transition for coders. The numbers of diagnostic codes included in the ICD-10 will increase from 13,500 to more than 69,000. For all inpatients procedures, numbers will increase from 4,000 to 71,000 codes.

Most coders have undergone extensive training to acquire the knowledge required to be a professional medical coder. In addition, a coder must be familiar with anatomy, medical terminology, insurance regulations and compliance. The coder will also be required to re-file insurance claims and be prepared for audits. A solid understanding is required to become a medical coder. Generally, using code books, the coder is able to assign specific ICD-9-CM codes that correctly corresponds to diagnosis of illnesses and injuries.

With the coming changes in the medical coding community, the more complex ICD-10 coding system will create several challenges for medical coders and billers. The mandate that requires the new coding system to be implemented in 2014 is intended to enhance quality of medical information by providing an opportunity to record much more specific information about the diagnosis disease and care of patients.

Comparing ICD-9 Codes with ICD-10 Codes

According to Centers for Medicare & Medicaid Services' GEMs (General Equivalence Mappings), comparable codes listed below are examples of how different the ICD-9-CM and the ICD-10-CM code will be:

For example, the ICD-9-CM code, 851.42, is the code for cerebellar or brain stem contusion without mention of open intracranial wound, with brief loss of consciousness.

The comparable ICD-10-CM codes that will be required are:

Another example of an ICD-9-CM Volume 3 code (procedure codes) and how the correct codes compare to the new ICD-10-PCS codes are:

ICD-9 code, 01.59, represents the designation of other excision or destruction of lesion or tissue of brain.

The comparable ICD-10-PCS codes that will be required are:

Technology to the Rescue

With the great expansion in the number of medical codes in ICD-10 vs. ICD-9 as well as the accompanying code information, usage notes and coding and billing instructions technological tools become a necessary part of any professional coder's toolbox. The computer (as well as tablets, pads, etc.) is an ideal tool for helping medical coders and billers lookup, compare, determine and research the codes necessary for filling out the medical records and claim forms.

Tools like the FindACode.com service can help medical billers and coders keep on top of all the changes and stay productive as they incorporate the new ICD-10 code sets into their work processes. Because billing and reimbursement is such a critical part of the health care industry, coders and billers will continue to play a crucial role. Keeping the coders and billers effective, efficient and always up to date will be a major challenge with the change in code sets from ICD-9 to ICD-10.

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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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