Medical coding industry past present and future


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Medical coding has witnessed significant changes over the past 20 years. This article highlights the advancements in medical coding and their advantages.

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Medical coding industry past present and future

  2. 2. Medical Coding Industry – Past Present and Future Medical coding which is an integral part of the medical billing and claims processing process has witnessed significant changes over the past 20 years. The eighties were a period when medical records were mostly handwritten, typed or transcribed. With the entry of computers, these machines were used to type medical documents that were stored on floppy disks or printed out using dot-matrix printers. There were no specially trained medical coders and the coding was done via a superbill or chargemaster marked by the physician. The processing of claims was rather cumbersome because the procedures and services had to be entered into computer software billing systems, the claims printed and mailed to the payers. Patient payments and insurance payments were received via snail mail. These had to be entered into the same software program; monthly statements recording a patient’s balance had to be printed out and mailed. As the technology expanded to computers, electronic health records began to replace paper charts and specialized software programs were developed to meet the administrative requirements of the medical office. In addition to that, healthcare data began to be quickly transmitted electronically via the internet. With technological revolution in the healthcare field, the coding process has become easy for coders as they can access the right information really fast. Online data transfer however involves the risk of unauthorized access to patient healthcare information. In addition to stringent HIPAA laws, healthcare providers, insurance companies and government agencies have established additional computer system requirements for the secure handling of online healthcare data. Most Common Code Sets Now In Use • CPT – In 1966, the American Medical Association (AMA) published this code set to describe medical, surgical and diagnostic services accurately. They are alphanumeric, five digit codes which include Category I codes (to describe a procedure or service), Category II codes (used for performance measurement) and Category III codes (temporary codes for new and emerging developments). • HCPCS Level II – These are five-digit alphanumeric codes which represent durable medical goods, medical supplies, non-physician services (for example, durable medical equipment, prosthetics, orthotics) and other services not included in the HCPCS Level I or CPT codes. This is used as an official code set for outpatient hospital care and chemotherapy drugs. This coding system was released by the federal government in the 1970s. • ICD-9 – International Classification of Diseases, Injuries, and Causes of Death (ICD), the global classification system for disease and mortality was adopted by the World Health Organization in the middle of the twentieth century. ICD-9-CM (Clinically Modified) was adopted by the U.S in 1979. It is the standardized code set for diagnostic and inpatient hospital coding and should be
  3. 3. used for medical claim billing. This coding manual includes Volume 1 (numeric listing of diseases classified by etiology and anatomical system, another classification of other reasons for encounters and causes of injury), Volume 2 (alphabetic index to locate Volume 1 codes) and Volume 3 (procedural classification). Medical coding systems now cover disabilities, prescription drugs, mental health and the dental field. With increase in the complexity of coding systems, specially trained medical coders have become indispensable. AAPC (American Association of Professional Coders) certified medical coders are well-trained in all the code systems and can ensure accurate medical coding and clean claims. Medical Coding Has Become Easier with Advanced Technology Instead of manual coding using the voluminous ICD-9CM diagnostic and CPT procedural coding manuals, medical coding can now be carried out using encoding software programs. The software allows a simple search of specific terms to get accurate codes faster and efficiently. It can analyze the digitized medical records to assign appropriate codes, validate the codes and ensure final submission to clients through webbased repository. This can definitely increase the coding efficiency. However, the service of an experienced, AAPC (American Academy of Professional Coders) certified medical coding specialist is still vital for reducing coding mistakes and ensuring proper reimbursement for providers. Future of Medical Coding The largest change coming to the U.S. healthcare industry is the replacement of ICD-9-CM codes with ICD-10 codes. The U.S. Department of Health and Human Services (HHS) has mandated that medical coders and billers use ICD-10 codes for reporting health are diagnoses and procedures from October 1, 2014. ICD10 includes more detailed codes to specify the exact condition so that the medical coders require a greater knowledge about anatomy and organ systems to assign accurate codes. For example, it uses combination codes to specify two diagnoses, a diagnosis with an associated secondary process or manifestation; and a diagnosis with an associated complication. The codes are expanded for: • Conditions and common symptoms or manifestations Example - K50.112 (Crohn’s disease of large intestine (condition) with intestinal obstruction (manifestation)) • Poisonings and external causes Example - T36.0x1D (Poisoning by penicillin’s (poisoning), accidental (unintentional), subsequent encounter (external causes))
  4. 4. Medical necessity is regarded as a prime requirement by most of the insurance companies, especially Medicare and Medicaid, to pay medical expenses. The preauthorization process requires the provider to prove via medical documentation that a particular service/procedure is medically necessary. With ICD-10 codes affording more specificity in medical coding, medical necessity can be more easily proven. Physicians can always go for the services of a professional medical billing and coding company that provides reliable medical coding services and benefit from efficient medical coding services from experienced medical coders. About Outsource Strategies International Outsource Strategies International, a leading medical coding company offers comprehensive medical coding services for medical groups, hospitals, ambulatory surgery centers, and coding companies throughout the United States. Take advantage of our Free Medical Coding Trial today! Send us up to 10 charts and let our certified coders (AAPC) code them for you for free. To learn more about our medical coding outsourcing services, call 1-800-670-2809.